Types of Episiotomy /Perineal Laceration

Types

1. Media: 

This is a midline incision which follows the line ofinsertion of the perineal muscle. It begins in the centre of the fourchette and directed posteriorly for about 2.5cm.

Advantages:

·              Causes less bleeding, because it does cut through any big blood vessels.

·              It is easy to repair and it heals better. It is more convinence for the woman.

Disadvantage

·              It may extend and damage the anus (third degree tear) or to the rectum (fourth degree tear).

·              It does not give enough room as medio-lateral for instrumental delivery and rotation used mainly in USA.

2. Medio-lateral: 

The incision begins in the centre of thefourchetter and directed to the right or left of the lateral margin of the anal-sphincter, diagonally in a straight line, at an angle of 450C between the tuberosity and the anus. It should not be more than 4-5cm long and about 2.5cm away from the anus. This line avoids damage to the anal sphincter and Bartholin’s gland.

Advantage:

·              Can not lead to 30C tear-recommended for midwives. Use more in U.K.

Disadvantage

·              It is more difficult to repair. Bilateral mediolateral episiotomy are not recommended, because it can cause excessive bleeding.

3. J-Shaped or Schuchardt incision

The incision begins in the centre of the fourchette and directed posteriorly in the midline for about 2cm and then directed laterally (at 7.Oclock) to avoid the anus. It helps in difficult deliveries e.g. large head, shoulder dystocia or difficult breech. It is difficult to suture and the wound tend to wrinkle.

4. Lateral Episiotomy

The incision begins about 1-2cm away from the centre of the fourchette. It cut across the labia majora, large blood vessel and Bartholin’s duct may be damaged.

Disadvantage

·              Causes profuse bleeding ,difficult to repair ,causes a lot of discomfort to the woman .It has been abadoned.