Operational Obstetrics & Gynecology

Labor and Delivery

Labor	Contractions	Electronic Fetal Monitors
Latent Phase Labor	Fetal Heart Rate	Pain Relief
Active Phase Labor	Urine	Second Stage Labor
Progress of Labor	Estimated Fetal Weight	Preparing for Delivery
Delivery of the Baby	Dilatation and Effacement	Managing the Delivery
Delivery of the Placenta	Fetal Orientation	Episiotomy
Managing Labor and Delivery	Leopold's Maneuvers	Anesthesia
Initial Evaluation	Fetal Membranes	Clamp the Cord
History	Blood Count	The Placenta
Risk Factors	Early Labor	Uterine Massage
Vital Signs	Monitor the Fetal Heart	Post Partum Care

Episiotomy

Sometimes, a small incision is made in the perineum to widen the vaginal opening, reduce the risk of laceration, and speed the delivery.

There are two forms, midline and mediolateral.

A midline episiotomy is safe, and avoids major blood vessels and nerves. It heals well and quickly and is reasonably comfortable after delivery.

If the fetal head is still too big to allow for delivery without tearing, the lacerations will likely extend along the line of the episiotomy. Lacerations through the rectal sphincter and into the rectum are relatively common with this type of episiotomy.

A mediolateral episiotomy avoids the problems of tearing into the rectum by directing the forces laterally. However, these episiotomies bleed more, take longer to heal, and are generally more uncomfortable after delivery.

In an operational setting, the major question is not so much where to put the episiotomy, but whether to perform this procedure at all.

If you don't perform an episiotomy, you are increasing the risk of vulvar lacerations, but these are usually (not always) small, non-threatening lacerations that will heal well without further complications.
If you perform a midline episiotomy, you will have fewer vulvar lacerations, but the few you have are more likely to be the trickier 3rd and 4th degree lacerations involving the anal sphincter and rectum.
If you perform a mediolateral episiotomy, you will avoid the 3rd and 4th degree lacerations, but you may open the ischio-rectal fossa to contamination and infection and increase the intrapartum blood loss.

The best approach is an individualized one, that takes into account your own training and expertise, the clinical circumstances, and the operational circumstances.

Home ╖ Introduction ╖ Medical Support of Women in Field Environments ╖ The Prisoner of War Experience ╖ Routine Care ╖ Pap Smears ╖ Human Papilloma Virus ╖ Contraception ╖ Birth Control Pills ╖ Vulvar Disease ╖ Vaginal Discharge ╖ Abnormal Bleeding ╖ Menstrual Problems ╖ Abdominal Pain ╖ Urination Problems ╖ Menopause ╖ Breast Problems ╖ Sexual Assault ╖ Normal Pregnancy ╖ Abnormal Pregnancy ╖ Normal Labor and Delivery ╖ Problems During Labor and Delivery ╖ Care of the Newborn

Bureau of Medicine and Surgery
Department of the Navy
2300 E Street NW
Washington, D.C
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Operational Obstetrics & Gynecology - 2nd Edition
The Health Care of Women in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMEDPUB 6300-2C
January 1, 2000

This web version of Operational Obstetrics & Gynecology is provided by The Brookside Associates Medical Education Division. It contains original contents from the official US Navy NAVMEDPUB 6300-2C, but has been reformatted for web access and includes advertising and links that were not present in the original version. This web version has not been approved by the Department of the Navy or the Department of Defense. The presence of any advertising on these pages does not constitute an endorsement of that product or service by either the Department of Defense or the Brookside Associates. The Brookside Associates is a private organization, not affiliated with the United States Department of Defense. All material in this version is unclassified.

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