LESSON PLAN ON
EPISIOTOMY
Mrs.Ruth shanthini.S
Associate professor,in OBG dept,
ICON
General objectives:The student will acquire adequate knowledge about episiotomy, gives the desirable attitude and develops the skill in
doing episiotomy for the patients in all the clinical settings.
Specific objective: The student will be able to,
define episiotomy
enlist the purposes of episiotomy
enumerate the principles of episiotomy
describe the indication for episiotomy
illustrate the timing of episiotomy
brief about types of episiotomy
list out the articles needed for episiotomy
explain the procedure of episiotomy and after care.
S.NO SPECIFIC TIME AV AIDS TEACHER’s & EVALUATION
OBJECTIVE CONTENT LEARNER’s
ACTIVITY
EPISIOTOMY Roller board Defining
1 Define 1 min DEFINITION: Listening What is
episiotomy A surgically planned incision on the perineum and posterior episiotomy?
vaginal wall during the second stage of labour is called
episiotomy. D.C.DUTTA
2 Enlist the 2 min Pamphlet Enlisting What are the
PURPOSE:
purposes of To aid the delivery of the presenting part when the and taking notes purposes of
episiotomy perineum is tight and causing poor progress in the episiotomy?
second stage of the labor.
To prevent perineum from tearing.
To allow space for operative or manipulative deliveries
(forceps and breech deliveries)
To shorten the second stage of labor, in case of fetal
distress.
To reduce pressure on the fetal head when delivering a
preterm infant.
To reduce prolonged maternal pushing efforts in case of
severe hypertensive or cardiac disease.
3 Enumerate 1 min Handout Enumerating Write the
PRINCIPLES:
the The apex of the episiotomy must be visualized and start Asking doubts principles of
episiotomy?
principles suturing from the apex.
of Dead space must be closed.
Tissues must be brought together but not strangulated
episiotomy
by excessive tension on the sutures.
Homeostasis must be obtained.
The needles must be handled with a pair of forceps and
not by hand, should be removed from the operating field
as soon as possible.
4 1 min INDICATION: Bulletin Describing What are the
Describe
Large sized babies board Listening indications for
the
Preterm or small for gestational age baby episiotomy?
indication Anticipation of shoulder dystocia
for Fetal malpresentation and malpositions.
episiotomy Thick perineum which is rigid and resistant to
distension.
Prior to any assisted delivery such as forceps/ventouse
To speed up delivery if there is fetal distress.
5 Illustrate
the timing 1 min TIMING OF EPISIOTOMY: Black board Illustrating Which is the time
of Bulging thinned perineum during contraction just prior to Listening for episiotomy?
episiotomy crowning is the ideal time.
TYPES IN EPISIOTOMY:
6 Brief about 2 min Median: The incision commences from the center of the Black board Explaining What are the types
fourchette and extends posteriorly along the midline for about of episiotomy?
types of
2.5cm. Taking notes
episiotomy
Lateral: The incision starts from about 1cm away from the
fourchette and extends laterally. It has got many drawbacks
including chance of injury to the Bartholin’s duct.
Mediolateral: The incision is made downward and outward
from the midpoint of the fourchette to either the right or the
left. It is directed diagonally in the straight line which runs
about 2.5 cm away from the anus.
J-shaped: the incision begins in the center of the fourchette
and is direct posteriorly along the midline for about 1.5cm and
then direct downward and outward long 5 or 7 o’clock position
to avoid the anal sphincter. Apposition is not perfect and the
repaired wound tends to be puckered.
PREPARATION OF THE MOTHER:
Provide privacy, adequate lightening.
Explain the procedure to patient.
Empty the bladder if needed
Encourage the mother to bear down.
7 List out the 1min ARTICLES NEEDED: Bulletin Listing out What are the
A Sterile tray containing: board Listening articles needed for
articles
Episiotomy scissor episiotomy?
needed for
Sponge holding forceps
episiotomy Bowl with antiseptic solution
Sims speculum
Needle holder
Toothed thumb forceps
Straight scissor
Gauze pad
Suture material
Syringe with inj. Xylocaine 2%
Kidney tray
8 Explain the 5 min PROCEDURE OF EPISIOTOMY: Power point Explaining What is procedure
Prefer the site of infiltration; insert and direct needle presentation for episiotomy?
procedure
beneath the skin at an angle of approximately 45º for Taking notes.
of
about 4-5 cm in the same line for a mediolateral
episiotomy episiotomy.
and after Withdraw the piston of the syringe to ensure needle has
care. not entered the blood vessel.
Infiltrate the perineum continuously as the needle is
slowly withdrawn.
Place two fingers in the vagina between the presenting
part and the posterior vaginal wall pointing downward,
Give a episiotomy (a single deliberate cut) during the
peak of uterine contraction when the birth is imminent.
Encourage the mother to bear down when there is good
uterine contraction.
Give perineal support with right hand and urethral
support with left and exert pressure over the occiput.
Apply pressure with gauze pad in the episiotomy
between contractions with a sterile gauze pad if there is
delay in delivery.
After delivery of baby, clean the perineum with
antiseptic solution and drape with central hole towel.
Inspect for any laceration, parauretheral tear, cervical
laceration.
Infiltrate with inj.xylocaine 2% in perineum.
Place the needle in the catgut in the tip of the needle
holder and hold the needle holder correctly.
Suturing is done by vaginal epithelium, muscle and skin
layer by continuous suturing.
After suturing perineum and rectum is examined for any
abnormalities.
AFTER CARE:
Place the sterile pad in genital area.
Position the mother in the supine position with cross
legs.
Clean and replace all the articles and instruments.
Record the time and type of episiotomy.
Check for any bleeding or hematoma.
SUMMARY:
In this class we have discussed about definition of episiotomy, purposes, indication, principles, timing, articles needed, types and
procedure with after care.
CONCLUSION:
The students are able to learn about episiotomy, types and procedure in detail and they will implement in their practical activities in
all clinical settings.
BIBLIOGRAPHY:
Manual of nursing procedures and practice, second edition, published by Wolters Kluwer pvt. Ltd., New Delhi. Page no: 847
to 853.
D.C DUTTA text book of obstetrical nursing 7th edition pg.no:647-649.
QUESTION PAPER
Answer the question appropriately (25 Marks)
I) Answer the following : any 22×2=4
1. Define episiotomy
2. What is the timing of episiotomy
3. Types of episiotomy
II) Answer in brief : any 22×3=6
1. what are the indications for episiotomy
2. what are the principles of episiotomy
3. articles needed for episiotomy
III) Answer in short: : 1×5=5
1. Nursing care for episiotomy patient
IV) Answer in detail: : 1×10=10
1. Procedure of episiotomy
Assignment:
Draw the diagram of female reproductive system and nursing process for patient with episiotomy.
