As we all know, a known case for OSCE’s. drop by a comment and feedback will ya.
Prof’s Azhar said they loves to ask this, well this info is courtesy of Prof’s Azhar and Dr. Sivakumar (left the college)
1.Prepare the episiotomy repairs set;
-Drapes
-Instruments
-Forceps
-Needle holder
-Scissors
-Swabs
-Gauze
-Pads
-Roller gauze
-Cleaning solution
-May include Catheter
-Analgesia ;Lignocaine
can be given thru:
-Local infiltration
-Pudendal injection
-Epidural
2. Take consent, and explain about the procedure ( how, what, why and any worries?)
3. Ensure good lightning
4. Assess the tear
1st degree tear -involving vagina mucosa and skin
2nd degree tear -tears involving mucosa and perineal muscle (levantor ani muscle)
3rd degree tear -tears involving anal sphincter
4rd degree tear – tears involving external and internal anal sphicter and anal mucosa
3rd degree and above – do in OT
5. Suture as quick as possible
Using Suture material
Polyglactin 910 – rapid (Vincryl)
Catgut chromic
Polyglactin 910 has been shown to have less pain and less analgesic use.
Reduced wound dehiscence and resuturing of the wound
*Count swabs and instrument before and after *
-Objective suture : to achieve good anatomical alignment and haemostasis.
6. Identify the apex
Suture above the apex and make a knot.
Ensure haemostasis
7. Continuous non locking sutures till reach the fourchette
8. PR examination – to look if you had accidentally suture the anal
9. Check wound again for missed tears & bleeding
10. Don’t forget to look for swabs or instruments and needles!
fav ques:
What layers that you sutured step by step
1st- Vagina Mucosa.
2nd- Perineal Muscle
3rd- Superficial skin
Legnote: those pics are there for a reason. Inadequacy and inaccurateness should be address. thanks!