Definition Episiotomy is an act of the operative incision in the perineum of the mucous membrane covering the vagina, the hymen ring, rektovaginal septal tissue, muscles and fascia of the perineum and the perineal skin.
INDICATION
Indications episiotomy can be derived from maternal factors and factors janin.1, 2
Maternal indications include:
a. Primigravida generally
b. Rigid perineum and perineal tear in the history of past labor
c. If there is excessive stretching of the perineum for example in breech delivery, delivery with pliers, vacuum extraction and big kids
d. The pubic arch is narrow
Fetal indications include:
a. Premature fetus during childbirth. Aim to prevent excessive trauma to the head of the fetus.
b. During fetal birth breech position, where the deflection, large fetus.
c. In circumstances where there is no indication to shorten the time as the emergency II fetuses, umbilical cord
Contra episiotomy indications include:
a. If vaginal delivery did not take place
vaginal introitus towards the back and sides. The direction of the incision can be made to the right or left, depending on the habits of people who do it. Long incision approximately 4 cm.
Deliberate cuts away here sphincter ani muscles to prevent ruptura perinei III level. Bleeding more injuries because the area involving a lot of blood vessels. Perineal muscles injuries truncated so that the sewing more difficult. Sewing is done in such a way that after the sewing is complete the results should be symmetrical.
c. Lateral episiotomy
Here incision made lateral direction from approximately 9 by 3 or counter-clockwise. This type of episiotomy is not done anymore now, because a lot of complications. Cuts can be widened in the direction where there is internal pudendal arteries, which can cause bleeding that much. Also happens scar can cause annoying pain sufferers.
d. Schuchardt incision.
This type is a variation of episiotomy mediolateralis, but sayatannya curved downward laterally, around the rectum, as well as wider incisi.
WHEN DO Episiotomy
If an episiotomy done too quickly, then the bleeding wounds arising from an episiotomy can be too much, whereas if an episiotomy is performed too slow muscles are the pelvic floor is stretched so that one’s own purposes episiotomy will not be achieved.
Based on the above many authors recommend an episiotomy performed during the fetal head was visible with a diameter of 3 to 4 cm at the time of his.
On the use of pliers some authors do an episiotomy after pliers inserted but before the traction is, on the grounds that if carried out before installation, will increase the bleeding and increase the risk of episiotomy wound expansion of uncontrolled during installation pliers.
Breech position at delivery, episiotomy should be done before the butt of birth, thus the extent of episiotomy can be tailored to the needs.
Stitches (REPAIR) episiotomy wound
Episiotomy wound sewing technique determines the results of episiotomy wound healing, even more important than the type of episiotomy itself. Sewing is usually done after the placenta is born, unless a lot of bleeding arising from episiotomy wound hemostasis is done first by binding or blood vessels open.
Some principles in the sewing episiotomy wound that must be considered is sebgai follows:
1. Disclosure is adequate episiotomy wound with good lighting, so the restoration of the anatomy of the wound can be done well.
2. Good hemostasis and prevent dead space.
3. Use a simple stitch yarn absorbed