Episiotomy Incision Research Articles

Could subcutaneous rifampicin administration be an effective approach for reducing episiotomy infections?

The aim of this prospective cross-sectional study was to investigate whether cleaning the episiotomy line with rifampicin solution before suturing will reduce infection and wound dehiscence in women who had vaginal delivery with episiotomy. A prospective cross-sectional study was conducted with a total of 400 primigravida patients. In the study group, irrigation with rifampicin of the subcutaneous tissue of the episiotomy incision was applied, and in the control group, there was no irrigation. Patients were evaluated for infection at the 1st, 3rd week, and 1-month controls. The groups were compared according to episiotomy infection and wound dehiscence rates. The episiotomy infection rate of the whole group was 8.5%, the wound dehiscence rate was 3.75%, and the average time of occurrence of the infection was 5.35±2.21 days. The most common infection findings were local pain and purulent discharge at 4.75%. In the control group, where the infection occurred earlier, the infection and wound dehiscence rates were significantly higher [11.5% vs. 5.5%; 6.0% vs. 1.5% (p<0.05)]. Purulent discharge was the most common finding in the control group, and local pain in the study group, but no significant difference was found between the two groups in terms of findings (p<0.05). When only the patients who developed episiotomy infection were evaluated among themselves, the only significant difference was found in wound dehiscence, which was higher in the control group (p<0.05). Considering the high rates of episiotomy in our country, subcutaneous irrigation with rifampicin is a good option that can be kept in the foreground due to its low cost and ease of application.

The Effects of Ginger (Zingiber officinale) Extract Ointment on Pain and Episiotomy Wound Healing in Nulliparous Women: A Randomized Clinical Trial.

Episiotomy is a usual midwifery surgery. Iran is a country with an abundant source of medicinal plants. This study aimed to investigate ginger extract ointment's effects on the pain and recovery of episiotomy incisions in nulliparous women. This randomized clinical trial was conducted in a public hospital in Iran on 70 nulliparous women with an episiotomy incision. The women were randomly assigned to ginger extract ointment and placebo groups. The primary outcomes included pain and wound healing that were assessed using a visual analog scale (VAS), redness, edema, ecchymosis/bruising, discharge, and an approximation scale (REEDA). The participants were followed up before discharge from the hospital and 5×1 and 10×1 days after the intervention. The secondary outcome was the number of painkillers used during the study. Data were analyzed by chi-square, independent t test, and the Mann-Whitney U via SPSS-13. The significance levels were determined to be P≤0.05. There was no significant difference between participants treated with ginger extract ointment and placebo in the pain and wound healing scores before the intervention, 5×1 and 10×1 days after the intervention. But, the pain intensity decreased, and the recovery speed increased clinically. Also, regarding the secondary outcome of this study, no significant difference between the placebo and intervention groups in the number of painkillers participants took. The ginger ointment could not significantly improve episiotomy wounds' pain and healing rate, but it was clinically helpful. So more studies with different doses of this ointment are needed.

Evaluation of Episiotomy Characteristics of EPISCISSORS-60 Scissors Compared with Mayo Scissors: A Single-Blind Randomized Clinical Trial.

It seems that angled scissors may be able to minimize the occurrence of obstetric anal sphincter injuries (OASIS) during vaginal delivery by correcting the angle of the episiotomy incision.For this purpose, this study aimed to evaluate the episiotomy characteristics of EPISCISSORS-60 scissors compared with Mayo scissors. In this single-blind clinical trial study, 64 pregnant women candidates for natural childbirth were included; 32 women underwent episiotomy with Mayo scissors and 32 underwent episiotomy with the EPISCISSORS-60 instrument. Then, post-suturing angle, incision length, episiotomy, postpartum pain, bleeding volume, and the incidence of OASIS and dyspareunia were assessed. The collected data were analyzed by independent sample t test, chi-square test, and the Fisher exact test. Episiotomy incision length in the EPISCISSORS-60 group with a mean of 4.75 ± 0.72 cm was significantly longer than the Mayo group with a mean of 3.91 ± 0.52cm (P < 0.001). In addition, the incidence of dyspareunia was not significantly different between the 2 groups (6.3% vs 15.6%; P = 0.426). Sphincter damage did not occur at all in the EPISCISSORS-60 group and only 2 cases of grade 3 sphincter rupture occurred in the Mayo group (P = 0.238). The mean of post suturing angle in the EPISCISSORS-60 group (59.09° ± 3.47°) was significantly higher than the Mayo group, with a mean of 31.06° ± 7.21° (P < 0.001). According to the results of the present study, the use of EPISCISSORS-60 can be associated with a higher post-suture episiotomy angle compared with Mayo scissors. As a result, both the incidence of OASIS and its long-term side effects, like dyspareunia, were decreased. However, in our study, the incidence of these complications was very rare and not different between the 2 groups.

EVALUATION of WOUND HEALING in EPISIOTOMY and CESAREAN INCISIONS USING REEDA SCALE

Some factors that prevent wound healing delay healing. Therefore, evaluation and monitoring of wounds is an important intervention. The use of scales in wound assessment is one of the factors that facilitate nursing care and increase the visibility of nursing functions. This descriptive and comparative study was conducted to evaluate wound healing in episiotomy and cesarean section incisions with the REEDA (Redness, Edema, Ecchymossıs, Discharge, Approximation) scale. The population of the study consisted of patients hospitalized in the gynecology and obstetrics clinic of a university hospital between 20.06.2019 and 02.08.2019, and the sample consisted of a total of 107 women, 53 of whom had a vaginal delivery with episiotomy and 54 who had a cesarean section. Research data were collected using the Patient and Wound Diagnosis Form, the REEDA Scale, and the Numerical Rating Scale. Statistical evaluation of the data was done using IBM SPSS 22 program and R programming language. On the 1st follow-up day of the study, it was determined that the REEDA scale total scores were higher in the episiotomy group and the difference was statistically significant (p&lt;0.05). It was observed that the total scores of the scale did not create a significant difference between the groups on the 3rd and 7th follow-up days (p&gt;0.05). In episiotomy incisions, the sub-subscale scores of the scale were higher on all follow-up days for redness, on the 1st and 3rd follow-up days for edema, and on the 1st follow-up day for discharge (p&lt;0.05). The sub-subscale scores in cesarean section incisions were found to be higher and statistically significant on the 3rd and 7th follow-up days for ecchymosis and on the 7th follow-up day for discharge and approximation (p&lt;0.05). According to REEDA scale scores, it was determined that the healing process in cesarean section wounds was longer than in episiotomy incision wounds.

Effect of uterine fundal pressure applied in the second stage of labor on birth outcomes and neonatal oxygen saturation.

To examine the effect of fundal pressure applied in the second stage of labor on birth outcomes and neonatal O2 saturation. The study is of a descriptive and comparative type. Research data were collected in the obstetrics clinic of a Maternity Hospital between August 15, 2019 and February 15, 2020. The study sample consisted of 160 pregnant women who met the research criteria (80 pregnant women who received fundal pressure, 80 pregnant women who did not receive fundal pressure). The duration of the second and third stages of labor was found to be shorter in the nonfundal pressure group (t=-3.422, p=0.001; t=2.195, p=0.030). When the groups were compared, the formation of perineal trauma and second-degree laceration, episiotomy requirement, elongation of the episiotomy incision and cervical laceration rate were found to be significantly higher in the fundal pressure group χ2 =10.794 p=0.001; χ2 =8.403 p=0.004; χ2 =10.014, p=0.002; χ2 =16.579 p=0.000; χ2 =16.276 p=0.000). The 1st and 5th min Apgar scores of the newborns were lower in the fundal pressure group (t=-6.377, p=0.000; t=-3.581, p=0.001). The 1st, 5th, 10th, and 15th min oxygen saturation of the newborns were determined to be significantly lower in the fundal pressure group (t=-4.753, p=0.000; t=-2.427, p=0.016; t=-2.604, p=0.010; t=-2.492, p=0.014). According to the study results, it was determined that the uterine fundal pressure has a negative effect on birth outcomes and neonatal oxygen saturation. Adverse effects of fundal pressure application should be revealed in different aspects.

Effect of a combination of infrared irradiation and magnesium sulfate wet compress on infection and healing of episiotomy incision in puerperae

Purpose: To investigate the effect of a combination of infrared irradiation and magnesium sulfate wet compress on infection and healing of episiotomy incision in puerperae during spontaneous delivery.&#x0D; Methods: A total of 120 puerperae who underwent lateral episiotomy in Jinan Maternity and Child Hospital Affiliated to Shandong First Medical University from January 2019 to January 2020 were used as study subjects. They were randomly assigned to group A (n = 60) and group B (n = 60). Group B received external application of anerdian, while group A was treated with infrared irradiation and magnesium sulfate wet compress, in addition to receiving the treatment given to group B. The two groups were compared with respect to perineal edema, levels of inflammatory factors, wound pain grading, degree of incision healing, incision healing time, and incidence of infection.&#x0D; Results: Group A patients had significantly lighter perineal edema and more pronounced pain relief than group B patients (p &lt; 0.05). The number of puerperae with grade A healing and grade C healing in group A was significantly higher than that in group B (p &lt; 0.05). Incision healing time and incidence of infection were lower in group A than in group B (p &lt; 0.05).&#x0D; Conclusion: The combination of infrared irradiation and magnesium sulfate wet compress effectively mitigates perineal edema in puerperae, reduces pain, enhances the healing of incision, and lowers maternal infection. Thus, this combination strategy may have some merit in clinical practice.

Evaluation the effect of Silybum marianum ointment on episiotomy wound healing and pain intensity in primiparous women: a randomized triple blind clinical trial

BackgroundEpisiotomy is the most commonn surgical procedure in midwifery which as any other wounds can cause infection or delay in healing.The current study aimed to determine effect of Silybum marianum ointment on pain severity and healing of episiotomy wound in primiparous women referring to Shahid Nourani Hospital at 2019.MethodsThis research was done as a randomized, triple-blind clinical trial on 87 priiparous women (44 indivdiuals in Silybum marianum ointment group and 43 indivdiuals in placebo group) referred to Shahid Nourani Hospital in Talesh (Guilan Province), Iran at September 2019.After labor and performing episiotomy, twice a day for 10 days as a fingertip size of the ointment was prescribed to be topically used on the episiotomy incision for both groups (Silybum marianum ointment or placebo ointment).Data gathering was done using demographic and midwifery information questionnaire, Episiotomy healing assessment: Redness, Edema, Ecchymosis, Discharge, Approximation)REEDA Scale (REEDA Scale: Redness(R); Edema (E), Ecchymosis(E), Discharge from the wound(D); Approximation of the perineal tissues(A))(scale, and visual analogue scale of pain. Examination of healing status of the perinea incision was performed during first 12 h, fifth day and tenth day after labor.Kolmogrov-Smirnov test was used in order to investiagte nomrality of data distribution of quantitative data, and two- independent samples t test, Chi square, repeated measures two factorial analysis of variance and Fischer’s exact test were used. SPSS software version 23 was used to analyze data and 0.05 was considered as signifcance level.ResultsBoth groups of Silybum marianum and placebo groups did not differ regarding demographic and midwifery characteristics, hygiene status prior to intervention (P > 0.05).Mean difference of pain severity and REEDA scale in Silybum marianum ointment group in 12 h after labor, at fifth day and tenth day after labor was significant comparing to control group which indicates decline in episiotomy pain severity and faster wound healing (P < 0.001).ConclusionsSilybum marianum ointment ointment accelerates episiotomy wound healing rate due to its healing properties and decreases pain severity.Trial registrationThis study was registered in Iranian Registry of Clinical Trials in 10/08/2019 with the IRCT ID: IRCT201811100411603N1.

In women with spontaneous vaginal delivery, repair of perineal tears might be easier compared to episiotomy.

To examine a common assumption that suturing of episiotomy, a straight performer-controlled incision, might be easier compared to repair of unpredictable spontaneous perineal tears. Data for this study were collected prospectively, as part of a randomized controlled trial examining the outcomes of episiotomy avoidance. Suturing characteristics were compared between vaginal deliveries with episiotomy vs. spontaneous perineal tears. Primary outcomes included the duration of the repair, number of suture packs used for the repair, and subjective rating of suturing difficulty (rated from 1 to 5 by practitioner performing the suturing). Of 525 vaginal deliveries, episiotomy was performed in 165 (31.4%) of the cases, 59 of which (35.8%) were accompanied by additional vaginal tears. Spontaneous vaginal tears without episiotomy were noted in 272 deliveries (51.8%). Compared to spontaneous perineal tears, episiotomy performance was associated with an adverse effect on all three suturing characteristics in the overall cohort and in subgroup of non-operative deliveries. When comparing episiotomy only to second-degree tear suturing, in the subgroup of non-operative vaginal deliveries a higher rate of suturing duration < 10min was noted in favor of spontaneous tears. However, in sub-analysis of vacuum-assisted deliveries, a benefit was noted in favor of the episiotomy-only group in terms of fewer suture packs and lower subjective difficulty. In women with non-operative vaginal delivery, suturing of spontaneous perineal tears was easier and shorter compared to episiotomy repair. This might be related to the unpredictable nature of perineal tears, which might be shorter and shallower compared to the standard episiotomy incision.

Práticas de cuidado no puerpério desenvolvidas por enfermeiras em Estratégias de Saúde da Família

Objetivo: conhecer as práticas de cuidado desenvolvidas por enfermeiras de Estratégias de Saúde da Família para mulheres no puerpério. Método: pesquisa qualitativa realizada entre dezembro de 2016 e janeiro de 2017 por meio de entrevista semiestruturada com nove enfermeiras. Os dados foram analisados conforme a proposta operativa. Resultados: as consultas puerperais acontecem em torno de uma a duas vezes dentro de 30 dias e são realizadas, majoritariamente, pelas enfermeiras por meio do exame físico obstétrico, cuidados com a incisão da cesariana ou episiotomia, avaliação de aspectos emocionais e orientações sobre sexualidade, planejamento reprodutivo, amamentação, cuidados com o recém-nascido e vínculo entre mãe e bebê. Conclusão: as enfermeiras percebem a relevância das práticas do cuidado e suas principais características, pois reconhecem as alterações hormonais, emocionais e sociais do período e a importância da atuação de profissionais nessa fase cercada por transformações, adaptações e vulnerabilidade.

Infiltracija hirurške rane hronični neuropatski bol kao posledica epiziotomije - postporođajni hronični neuropatski bol

Introduction: Chronic postsurgical pain has an estimated mean incidence of 30% and varies according to the type of surgery and patient characteristics. The pain can be severe and result in clinically relevant functional impairment reported by 5-10% of patients. Epidemiological surveys have shown that many patients with neuropathic pain do not receive appropriate treatment. Bio-psycho-social model of chronic pain is highly expressive in neuropathic pain management and requires the adjustment of the therapeutic approach. Case Report: A 37-year-old female complained of numbness, burning, and discomfort of the perineum. In 2016, after the vaginal baby delivery followed by episiotomy, she experienced discomfort and variety of painful sensations in the episiotomy incision region. A year later, after a hemorrhoid surgery followed by episiotomy scar reconstruction symptoms intensified with a strong influence on the patient's psychosocial condition. Consultation of obstetrician, psychiatrist and neurologist took part. Nevertheless, after two years had passed without significant clinical improvement, the patient was referred to a pain specialist. The pain specialist noticed inconsistency in the current treatment and the pain assessment was done only by one specialist. Testing revealed severe symptoms of hyperalgesia and allodynia, impaired psychosocial functioning related to chronic postsurgical pain. Pregabalin and duloxetine were introduced into the therapy and significantly improved pain relief and psychosocial functioning. Conclusion: Chronic postsurgical neuropathic pain is a complex syndrome which is not necessarily related to extensive surgical stimulus. The multidisciplinary therapy approach is crucial. Health providers who understand bio-psycho-social origin of chronic pain should be members of a multidisciplinary team.

1081: Suturing of episiotomy incision is not easier than repair of spontaneous perineal tears

Episiotomy is a common procedure worldwide; however, its value in prevention of various maternal and neonatal complications remains unproven. One of the common assumptions is that suturing of episiotomy, a straight incision which length and depth are determined by the obstetrician, might be easier compared to repair of unpredictable spontaneous perineal tears. The objective of our study was to examine this hypothesis. The data for this study was collected prospectively, as part of randomized controlled trial that examined the effects of episiotomy avoidance on advanced perineal tears in women towards their first vaginal delivery, compared to standard care. For the current analysis we compared suturing characteristics between two groups: vaginal deliveries in which episiotomy was performed, vs. deliveries with spontaneous perineal tears. Suturing characteristics included the duration of the repair, amount of suture packs and subjective rating of suturing difficulty (rated from 1 to 5). Of 525 vaginal deliveries, episiotomy was performed in 165 (31.5%) of the cases, 60 of which (36.4%) were accompanied by additional vaginal tears. Spontaneous vaginal tears without episiotomy were noted in 182 deliveries. The two groups did not differ in terms of various demographic and obstetric characteristics (age, body mass index, gestational age or birthweight); however, in the episiotomy group longer second stage and a higher percentage of vacuum extraction deliveries were noted (Table 1). No difference in the amount of suture packs or suturing difficulty was found between the two groups; however, in episiotomy group significantly higher rates of suturing duration above 10 minutes were noted (Table 1). According to our results, suturing of episiotomy is not easier, and might even be more complicated than the repair of spontaneous perineal tears. It might be related to the unpredictable nature of perineal tears, which might be shorter and shallower compared to the standard episiotomy incision.

A comparison of sexual function in primiparous and multiparous women

Childbirth is one of the most important influencing factors for sexual function. Therefore, this study was conducted with the aim of comparing sexual function in primiparous and multiparous women. This cross-sectional analytical study was performed using systematic random sampling on 420 women in the postpartum period who referred to Bandar Abbas health Centres in 2018. The data were collected using an interview method which consisted of a Female Sexual Function Index questionnaire and a demographic questionnaire. The data analysis was performed using the SPSS Version 23 software. The results showed that sexual dysfunction was lower in multiparous women compared to primiparous women (p = .006). Low sexual activity in primiparous women can be due to less privacy and more time and energy loss. Several factors including housing situation, monthly income, episiotomy incision, and the education level of the couple were influential in the sexual function of the primiparous women (p < .05). Sexual function differs between primiparous and multiparous women in postpartum period and the number of deliveries can affect sexual performance.IMPACT STATEMENTWhat is already known on this subject? Sexual function in humans is affected by a complexity of interactions. Childbirth is among the most one of the important factors that influences sexual function. Pregnancy and childbirth affect all organs of the female body, especially the genital tract, and the resulting changes may cause problems in sexual intercourse. Negative childbirth experiences from previous deliveries can affect sexual performance.What do the results of this study add? Regarding the high prevalence of sexual problems during the postpartum period and the direct impact of this on spousal relationship, and also given the controversial data on the relationship between parity and sexual dysfunction, the present study was conducted to compare postpartum sexual function between primiparous and multiparous women.What are the implications of these findings for clinical practice and/or further research? The sexual and emotional intimacy of couples may be affected due to the changes in women’s sexual function as the result of physiological and anatomical changes during pregnancy and postpartum. Therefore, to improve the quality of sexual relations, screening and counselling for sexual disorders should not be limited to pregnancy and postpartum periods, but should also be included in pre-pregnancy counselling centres.

Evaluation of Accuracy of Episiotomy Incision in a Governmental Maternity Unit in Palestine: An Observational Study.

Episiotomy should be cut at certain internationally set criteria to minimize risk of obstetric anal sphincter injuries (OASIS) and anal incontinence. The aim of this study was to assess the accuracy of cutting right mediolateral episiotomy (RMLE). An institution-based prospective cohort study was undertaken in a Palestinian maternity unit from February 1, to December 31, 2016. Women having vaginal birth at gestational weeks ≥24 or birthweight ≥1000 g and with intended RMLE were eligible (n=240). Transparent plastic films were used to trace sutured episiotomy in relation to the midline within 24-hour postpartum. These were used to measure incisions' distance from midline, and suture angles were used to classify the incisions into RMLE, lateral, and midline episiotomy groups. Clinical characteristics and association with OASIS were compared between episiotomy groups. A subanalysis by profession (midwife or trainee doctor) was done. Less than 30% were RMLE of which 59% had a suture angle of <40° (equivalent to an incision angle of <60°). There was a trend of higher OASIS rate, but not statistically significant, in the midline (16%, OR: 1.7, CI: 0.61–4.5) and unclassified groups (16.5%, OR: 1.8, CI: 0.8–4.3) than RMLE and lateral groups (10%). No significant differences were observed between episiotomies cut by doctors and midwives. Most of the assessed episiotomies lacked the agreed criteria for RMLE and had less than optimal incision angle which increases risk of severe complications. A well-structured training program on how to cut episiotomy is recommended.

Are we performing episiotomies correctly? A study to evaluate French technique in a high-risk maternity unit

IntroductionThe aim of this study was to evaluate episiotomy technique, in particular suture angles, and any correlation between suture angle and severe perineal tears. Material and methodsAn observational questionnaire-based study was conducted between 01 August 2015 and 30 April 2016 among accoucheurs performing episiotomies in a French maternity unit with facilities for high-risk pregnancies. For each patient included, accoucheurs were asked to measure the episiotomy suture angle, and to record the angle at which they thought they had cut, the length of the episiotomy, its distance from the anus, and whether the woman sustained a sphincter injury. ResultsThe centre's episiotomy rate during the study period was 15%. We analyzed the characteristics of episiotomies performed on 89 women (68 by doctors and 21 by midwives). Only 43% of suture angles were between 45° and 60° (45.6% of those performed by doctors vs 38.1% by midwives, p=0.8623), whereas 91% of accoucheurs thought they had cut within the correct range. Doctors made longer incisions than midwives (4 [4.2–5.0] vs 3 [2.5–3.5] cm, p=0.0006). Only 40.5% of accoucheurs correctly estimated the incision angle. Twelve (13.64%) of the 88 women sustained a third-degree perineal tear. The risk of sphincter injury was higher with suture angles <45° (odds ratio 5.46 [1.11–26.75], p=0.037). After multivariate analysis, this result was no longer significant (p=0.079). ConclusionIt appears that many accoucheurs have difficulty estimating episiotomy incision angles correctly and that education and training in this domain requires improvement.

Maternal Morbidity in Vaginal Delivery with or without Episiotomy in Nulliparous Women

Introduction: Episiotomy incision is the most common surgical procedure around the globe and in many countries, it became a routine policy. Episiotomy in all women with vaginal delivery has no benefit. Rate of episiotomy varies widely around the globe, while in Nepal all nulliparous and primi-parous hospital deliveries are given routine episiotomy. So, this study aimed to compare the maternal morbidity during first vaginal birth in women with or without episiotomy.Methods: This is a hospital based randomized prospective comparative study conducted in the Obstetrics and Gynaecology department of a teaching hospital. The subjects were divided into episiotomy group and no episiotomy group. Under local anaesthesia mediolateral episiotomy was given in the second stage with crowning of the head in episiotomy group. Nature of morbidity seen were recorded in both the groups immediately after delivery, after 6 hours and after 1 week and compared.Results: In no episiotomy group intact perineum 26.3%, laceration 10.5%, spontaneous perineal tear (first and second degree) 63.1% was observed. Total perineal surgical repair was 81.55%. Intact perineum was high among no episiotomy group. Third degree tear, vulval haematoma, wound gaping, perineal oedema were seen in episiotomy group.Conclusion: Anterior perineal laceration rate was high in no episiotomy group than episiotomy group but overall few morbidities were in no episiotomy group than in episiotomy group. So, episiotomy should not be considered to prevent insignificant anterior perineal lacerations.

The optimal angle of the mediolateral episiotomy at crowning of the head during labor

The aim of the mediolateral episiotomy incision is to increase the diameter of the soft tissue of the vaginal outlet to facilitate birth and to prevent vaginal tears. Episiotomy angles that are too narrow and close to the midline increase the risk of obstetric anal sphincter injuries. In order to determine the optimal angle of the episiotomy, we assessed the changes in the angles of episiotomy lines marked during the first stage of labor and measured at the time of crowning of the head. Incision lines for mediolateral episiotomy were marked on the perineal skin at angles of 30°, 45°, and 60° from the midline during the first stage of labor in women with a singleton pregnancy. The angles of the marked lines were measured at crowning of the head. Mediolateral episiotomy was performed only for obstetric indications. The study included 102 women with a singleton pregnancy. Of these women, 50 were primiparous and 52 were multiparous. All angles marked during the first stage of labor increased significantly (by more than 30°) at crowning of the head. Similar changes were observed in primiparous and multiparous women. The angle of the mediolateral episiotomy line was significantly greater at crowning of the head than when marked during the first stage of labor. To achieve the desired episiotomy angle, it is important to take into consideration the changes in mediolateral episiotomy angles that occur during labor.

Effects of entonox in comparison of lidocaine on pain severity during episiotomy incision in nulliparous women: A randomized control trial

Background & aim: Episiotomy is one of the most common surgical procedures in obstetrics, which requires analgesia. Entonox gas is known to have analgesic and sedative properties. However, no studies have been found on the analgesic effects of Entonox on episiotomy incision. Therefore, this study aimed to compare the effects of Entonox and lidocaine on pain intensity during episiotomy incision in nulliparous women. Methods: This randomized controlled trial was conducted on 120 term nulliparous women, who met the inclusion criteria. Subjects were selected by randomized sampling and equally divided into two groups of intervention and control (n=60). In the intervention group, Entonox gas was applied two minutes before episiotomy incision until the end of the procedure. On the other hand, the control group received 5 ml of lidocaine 2% as routine care before episiotomy incision. Data were collected using visual analogue scale to compare the study groups in terms of pain intensity. In addition, patient satisfaction with pain management technique during episiotomy and side effects of Entonox were assessed. Data analysis was performed in SPSS version 22 using Mann-Whitney U and Chi-square tests, and P value of less than 0.05 was considered statistically significant. Results: In this study, no significant difference was observed between the intervention and control groups regarding pain intensity (P=0.52). Moreover, no significant difference was observed in the satisfaction level of the two groups (P=0.70). Conclusion: According to the results of this study, Entonox could be used as an effective and noninvasive alternative to lidocaine to reduce pain during episiotomy incision without significant side effects.

Clonidine as an Adjuvant to Lignocaine Infiltration for Prolongation of Analgesia after Episiotomy.

Background:Epidural labor analgesia has not been fully accepted despite many advantages. Many times, the pregnant females reach hospital without antenatal checkup, and at that time, “episiotomy infiltration” becomes an ideal method for vaginal delivery. One of the most important problems after episiotomy is the severe perineal pain on the 1st day of postpartum period.Objectives:We compared the efficacy of clonidine 1 μg/kg as an adjuvant to 20 mg/ml lignocaine infiltration along the line of episiotomy incision for prolonging the duration and quality of analgesia with respect to various activities by single injection.Methodology:Majority of the patients, 94.2% in our study, had no idea about labor analgesia, and only 2.5% of all the patients expressed their interest to deliver without suffering from labor pains. One hundred and twenty pregnant female patients scheduled for full-term vaginal delivery were assigned into lignocaine and lignocaine-clonidine group according to infiltration they received. Pain scoring using visual analog scale and maternal satisfaction scale was monitored. At the end of the research project, the data were compiled and analyzed using appropriate statistical tests.Results:Duration of analgesia after episiotomy during sitting, walking, and squatting was 22.7 ± 1.32, 21.73 ± 1.47, and 19.875 ± 1.48 h in clonidine + lignocaine group and 6.06 ± 1.26, 5.33 ± 1.18, and 4.01 ± 1.28 h in lignocaine only group, respectively, which was highly statistically significant P < 0001.Conclusions:Clonidine when added to 2% lignocaine infiltration in episiotomy improves the quality and significantly enhances the duration of analgesia.

Obstetric anal sphincter injuries: review of anatomical factors and modifiable second stage interventions

Obstetric anal sphincter injuries (OASIs) are the leading cause of anal incontinence in women. Modification of various risk factors and anatomical considerations have been reported to reduce the rate of OASI. A PubMed search (1989–2014) of studies and systematic reviews on risk factors for OASI. Perineal distension (stretching) of 170 % in the transverse direction and 40 % in the vertical direction occurs at crowning, leading to significant differences (15–30°) between episiotomy incision angles and suture angles. Episiotomies incised at 60° achieve suture angles of 43–50°; those incised at 40° result in a suture angle of 22°. Episiotomies with suture angles too acute ( 60°) are associated with an increased risk of OASI. Suture angles of 40–60° are in the safe zone. Clinicians are poor at correctly estimating episiotomy angles on paper and in patients. Sutured episiotomies originating 10 mm away from the midline are associated with a lower rate of OASIs. Compared to spontaneous tears, episiotomies appear to be associated with a reduction in OASI risk by 40–50 %, whereas shorter perineal lengths, perineal oedema and instrumental deliveries are associated with a higher risk. Instrumental deliveries with mediolateral episiotomies are associated with a significantly lower OASI risk. Other preventative measures include warm perineal compresses and controlled delivery of the head. Relieving pressure on the central posterior perineum by an episiotomy and/or controlled delivery of the head should be important considerations in reducing the risk of OASI. Episiotomies should be performed 60° from the midline. Prospective studies should evaluate elective episiotomies in women with a short perineal length and application of standardised digital perineal support.

Effect of episiotomy on perineal lacerations in spontaneous vertex deliveries

Objectives: To evaluate the effects of episiotomy on the frequency of perineal lacerations. Design: Cross-Sectional analytical study. Place &amp; duration of study: Department of Gynae Obstetrics unit III. Lady willingdon Hospital Lahore. From April 1994 to March 1996. Patients &amp; methods: 2918 women who delivered vaginally were included in the study. Only right mediolateral episiotomy incision was used in these cases. Local anaesthesia in the form of 2% Lignocain was used in all cases to infiltrate the area before episiotomy cut. The delivery was conducted in most cases by a resident. The rate of perineal lacerations with or without episiotomy in both primiparae and multiparae groups was noted. Results 2918 women of term singleton babies were entered into this study. Episiotomy was performed in 1419 (48.63%) of these women. There were 1095(37.53%) primiparae and 1823 (62.47%) multiparae in the study groups. The rate of episiotomy in primiparae and multiparae were 93.42% and 21.72% respectively. A total of 267 (9.2%) perineal tears were sustained by these women during vaginal delivery . Episiotomy was associated with 151 (10.6%) perineal tears compared to 116(7.7%) without episiotomy. The incidence of fourth degree perineal laceration was 0.4% without episiotomy but increased to 1% with the use of episiotomy. This difference is statistically significant. Conclusion: Episiotomy is not protective against severe perineal lacerations. A selective use of episiotomy is recommended for appropriate indications.