episiotomy /epē′zē·ot″əmē/ [Gk, episeion, pubic region, temnein, to cut] , a surgical procedure in which an incision is made in a woman’s perineum to enlarge her vaginal opening for delivery. It is performed most often electively to prevent tearing of the perineum, to hasten or facilitate birth of the baby, or to prevent stretching of perineal muscles and connective tissue thought to predispose to subsequent abnormalities of pelvic outlet relaxation, as cystocele, rectocele, and uterine prolapse. Its prophylactic efficacy is debated. It is usually required for a forceps delivery. The incision into the vaginal and perineal tissue is closed with absorbable sutures that need not be removed. Deep incisions require closure in two or more layers. Immediate complications include hemorrhage and extension of the incision along the vaginal sulcus or into the anal sphincter or rectum. Delayed complications include hematoma and abscess. Application of cold packs to the perineum for several hours immediately after delivery minimizes swelling. Later alternating applications of heat and cold and warm sitz baths reduce discomfort, but sitz baths longer than 10 minutes soften tissue and prolong healing time. See also mediolateral episiotomy, median episiotomy.
