الفهرس 
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Abstract
The objective of this study to compare between
mediolateral and lateral episiotomies in primparaous
patients as regards the duration of repair of the wound.
To test this hypothesis, we conducted a single-blind
randomized controlled trial in women requiring episiotomy.
In the second stage of labor, 334 pregnant women
received an episiotomy in Ain Shams University, Maternity
Hospital were chosen to participate in the study after
obtaining a verbal consent. They were randomly allocated
into two groups, group I (lateral episiotomy) and group II
(mediolateral episiotomy), randomization was done using
opaque sealed envelopes.
group I: lateral episiotomy, incision beginning 1–2 cm
laterally from the midline and directed toward the
ischial tberosity.
group II: mediolateral episiotomy, incision beginning in
the midline at the posterior fourchette and directed
at an angle of at least 60° toward the Ischial
tuberosity.
Summary
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All of them were subjected to:
Full history for each patient, general, abdominal and
vaginal examination.
Routine laboratory investigations.
Abdominal ultrasound.
Management of second stage of labor.
Patient were in lithotomy position.
Sterilization, toweling and +/- catheterization were
done.
Local Anesthesia (xylocaine) was offered to all
patients before doing the Episiotomy by a proper time
(5ml.international units).
Episiotomy was done either lateral or mediolateral,
when the fetal head crowns the perineum. During
head delivery, Ritgen’s maneuver technique was used
including: the head distends the vulva and perineum
(during a contraction) enough to open the vaginal
introitus to a diameter of 5cmor more, towel-draped,
gloved hand was used to exert forward pressure on the
chin of the fetus through the perineum just in front of
the coccyx. At the same time, the other hand exerts
pressure superiorly against the occiput.
Summary
89
Management of the third stage of labor that ends by
delivery of placenta and its attached membranes.
Oxytocin commonly used in the management of the
third stage of labor.
Repair of the episiotomy, Cervical examination using
the ring forceps for detection of any tear.
Then, the delivering provider examined the extent of
the laceration after delivery by per rectum examination,
carefully evaluating for possible extension to third- or
fourth-degree laceration. 2-0 braided polyglycolic acid
(vicryl -Truglyde) sutures will be used for the repair.
With 2 fingers placed in the vagina for retraction, the
apex of the episiotomy site is identified, and a suture is
secured approximately 1 cm distally. The submucosal
tissue and vaginal mucosa were reapproximated in a
continuous fashion (either nonlocked or locked). A deep
episiotomy or laceration may require additional submucosal
sutures for appropriate tissue reapproximation and closure
of dead space.
The bulbospongiosus muscle generally repaired which
is performed with a subcuticular stitch. Sutures were placed
perpendicular to the angle of the incision to prevent
Summary
90
anatomic distortion of the perineum and vaginal opening
(Hale et al., 2007).
*If Lateral episiotomy was done, The Incision was
beginning 1–2 cm laterally from the midline and directed
toward the ischial tuberosity.
The repair of the lateral episiotomy had the same steps
as that of mediolateral episiotomy.
Vicryl 2.0 braided polyglycolic acid (vicryl -Truglyde)
suture is used for repairing the tear.
Both groups of patients were offered parenteral
Antibiotics (1.5gm ampicillin sulbactam –unacyn
pfizer) during delivery and rectal analgesics postpartum
for one to two weeks.
The patients were followed up to 10 days postoperative
All of the women were invited by telephone
during this period. Women were asked to report any
problems occurred in this 10 days to manage any postoperative
complication