What is an Episiotomy and How is It Repaired?
As a woman pushes during the second stage of labor, descent of the fetal head onto the maternal perineum can lead to a significant amount of trauma depending on the clinical situation.
Most of the time, the superficial skin of the vulva gives way upon emergence of the head, and either no laceration occurs, or there can be tearing. As the fetal head is crowning, it is the discretion of the Obstetrician as to whether to allow tearing or to cut an episiotomy.
An episiotomy is a surgical incision in the tissue that involves the opening of the vagina.
It is usually done at 6-oclock between the vagina and the rectum, or it occurs off to the side (right mediolateral episiotomy). There are advantages an disadvantages of tearing vs. MLE (midline episiotomy). Tearing can be extensive and since it is often jagged can be harder to repair.
MLE is the most common episiotomy, and with a well controlled head upon delivery, and with not creating the MLE until the head is crowning, it is safe and effective, and healing is less painful than with RMLE. RMLE are done off to the side and help to avoid higher degree lacerations (like 3rd or 4th degrees) as they avoid the trajectory with the rectum, but the healing is harder, longer and more painful than with an MLE.
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