Managing Complications in Pregnancy and Childbirth: - IAWG

EPISIOTOMY P-71Episiotomy should not be performed routinely.• Review for indications.Episiotomy should be considered only in the case of:• complicated vaginal delivery (breech, shoulder dystocia,forceps, vacuum);• scarring from female genital cutting or poorly healed third orfourth degree tears;• fetal distress.• Review general care principles (page C-17) and apply antisepticsolution to the perineal area (page C-22).• Provide emotional support and encouragement. Use localinfiltration with lignocaine (page C-38) or a pudendal block (pageP-3).• Make sure there are no known allergies to lignocaine or relateddrugs.• Infiltrate beneath the vaginal mucosa, beneath the skin of theperineum and deeply into the perineal muscle (Fig P-39, page P-72) using about 10 mL 0.5% lignocaine solution (page C-39).Note: Aspirate (pull back on the plunger) to be sure that no vesselhas been penetrated. If blood is returned in the syringe withaspiration, remove the needle. Recheck the position carefully andtry again. Never inject if blood is aspirated. The woman can sufferseizures and death if IV injection of lignocaine occurs.• At the conclusion of the set of injections, wait 2 minutes and thenpinch the incision site with forceps. If the woman feels the pinch,wait 2 more minutes and then retest.Anaesthetize early to provide sufficient time for effect.