EPISIOTOMY
| A | Classical Cesarean Section | |
| B |
Hysterotomy |
|
| C |
Episiotomy |
|
| D |
All of the above |
Scar endometriosis can occur following :
| A |
Classical Cesarean Section |
|
| B |
Hysterotomy |
|
| C |
Episiotomy |
|
| D |
All of the above |
Ans. is d i.e. All of the above
Endometriosis sometimes occurs in abdominal wall scars following operations on uterus or tubes and is known as Scar endometriosis.
Operations most likely to be followed by scar endometriosis
- Hysterotomy
- Classical cesarean section
- Ventrofixation
- Myomectomy
- Following operations for removal of pelvic
- Following operations for section of Fallopian tube
- Episiotomy
- endometriosis
| A | Ease of repair | |
| B |
Fewer breakdowns |
|
| C |
Less blood loss |
|
| D |
Less extension of the incision |
Midline episiotomies are easier to fix and have a smaller incidence of surgical breakdown, less pain, and lower blood loss. The incidence of dyspareunia is somewhat less. However, the incidence of extensions of the incision to include the rectum is considerably higher than with mediolateral episiotomies.
| Type of Episiotomy | Type of Episiotomy | |
| Characteristic | Midline | Mediolateral |
| Surgical repair | Easy | More difficult |
| Faulty healing | Rare | More common |
| Postoperative pain | Minimal | Common |
| Anatomical results | Excellent | Occasionally faulty |
| Blood loss | Less | More |
| Dyspareunia | Rare | Occasional |
| Extensions | Common | Uncommon |
Ref: Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 17. Normal Labor and Delivery. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
Most suitable method of treating 4 inch size episiotomy hematoma is by :
| A |
Evacuation |
|
| B |
Magsulf compression |
|
| C |
Cold compress |
|
| D |
Marsupialisation |
Evacuation
The most important step in the treatment of a badly infected episiotomy is :
| A |
Securing cultures |
|
| B |
Antibiotics |
|
| C |
Hot sitz baths |
|
| D |
Drainage |
Drainage
Episiotomy is best done :
| A |
Medially |
|
| B |
Laterally |
|
| C |
Mediolaterally |
|
| D |
J shaped |
Mediolaterally
Advantages of median episiotomy over mediolateral episiotomy are all except:
| A |
Less blood loss |
|
| B |
Easy repair |
|
| C |
Extension of the incision is easy |
|
| D |
Muscles are not cut |
Ans. C: Extension of the Incision is Easy
A mediolateral episiotomy is performed by making a diagonal incision across the midline between the vagina and anus.
The disadvantages are:
- Apposition of the tissues is not so good.
- May require more healing time than the midline incision.
- Blood loss is a little more
- Postoperative discomfort is more
- Relatively increased incidence of wound disruption
- Dyspareunia is comparatively more
The advantages are:
- If necessary the incision can be extended.
- Relative safety from rectal involvement from the extension.
