Episiotomy

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°
• Myomectomy°                                                                              • Ventrofixation°
• Following operations for section of Fallopian tube°                    • Following operations for removal of pelvic
• Episiotomy°                                                                                     endometriosis°

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. 

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.

Evacuation

Drainage

Mediolaterally

Ans. C: Extension of the Incision is Easy

Mediolateral episiotomy is performed by making a diagonal incision across the midline between the vagina and anus This method is used much less often.

The disadvantages are:

• Apposition of the tissues is not so good.
• May require more healing time than the midline incision.
• Blood loss is little more
• Postoperative discomfort is more
• Relative 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 extension.