TECHNIQUE FOR SUTURING EPISIOTOMY/VAGINAL/PERINEAL LACERATIONS

REQUIREMENTS #

1. Suturing materials (Chronic cutgut)
2. Sterile swabs
3. Tampoule
4. Vaginal pads
5. Suture handle
6. Suturing scissors
7. Good light source
8. Anaesthetic agent

STEPS #

1. Ask your assistant to adjust light source for visibility
2. Clean perineal area and apply a new bed mat
3. Sit down and make self-comfortable
4. Ensure aseptic technique throughout the procedure
5. Open the suture and gently stretch it out until it is straight. Choose appropriate suture material
6. Place the needle in the needle holder and adjust it firmly
7. Run your finger through the whole laceration to determine the depth and length
8. Place your first suture about 1 cm above the top (apex) of the wound/episiotomy and make a strong knot
9. Suture the vaginal mucosa using a continuous stitch, bringing together the cut/lacerated edges, sewing down to the hymenal ring
10. Put the needle through the vaginal mucosa behind the hymenal ring, and bring it out on the laceration of the perineum
11. Suture the perineum together using the suture sparing continuous/interrupted method to suture all the way to the bottom of the wound
12. Once you have reached the very end of the wound, turn the needle over and start to sew again using continuous stitches to close the subcuticular tissue
13. Move the suture again from the perineal part of the wound back into the vagina and secure it
14. Tie off the suture again from the perineal part of the wound back into the vagina
15. Remove the vaginal pack and double check to make certain that you have not left any gauze, tampon, or instruments in the woman’s vagina
16. Insert one finger in the vagina to check the firmness of the suture line
17. Perform a rectal examination to check that no stitch is in the rectum if this is a midline laceration or episiotomy
18. Clean perineal area including the buttocks and thighs
19. Encourage the woman to pass urine and expel clots
20. Make sure the uterus is well contracted
21. Administer prescribed analgesic
22. Cover the vulva with a sterile pad
23. Make the woman dry and comfortable
24. Educate woman on care of the perineum
25. Dispose off and decontaminate used instruments
26. Perform hand hygiene
27. Express appreciation to the woman for her cooperation
28. Check the blood pressure, pulse and temperature
29. Observe for bleeding
30. Leave the woman to rest for at least 1 hour
31. Record and report findings to the Officer in-charge