Episiotomy Repair
What is Episiotomy Repair?
An episiotomy repair is a surgical procedure to close a deliberate incision made in the perineum (the area between the vagina and anus) during vaginal delivery to facilitate birth and prevent uncontrolled tearing. The repair involves suturing the incision to promote healing and restore anatomy. In India, episiotomy repair is performed in obstetrics and gynecology departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, typically as part of delivery care. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for new mothers in India to make informed decisions.
Why do you need Episiotomy Repair?
Episiotomy repair is indicated for:
- Episiotomy incision:
- Performed during vaginal delivery to widen the birth canal, often in cases of fetal distress, prolonged second stage of labor, or to prevent severe perineal tears (e.g., with a large baby, shoulder dystocia, or forceps/vacuum delivery).
- Perineal tears (if episiotomy extends):
- First-degree: Skin only.
- Second-degree: Skin and perineal muscle (most episiotomies are second-degree).
- Third/fourth-degree (rare with episiotomy): Extends to anal sphincter or rectum (repaired similarly but with added complexity).
- Routine vs. selective use:
- Historically routine, now selective per WHO guidelines (only 10–20% of vaginal births require episiotomy, based on clinical need).
The procedure aims to close the incision or tear, minimize infection, reduce pain, and restore perineal function (e.g., for continence and sexual activity) while promoting healing.
Why Do Episiotomy Repair Costs Vary in India?
Costs are typically bundled with delivery charges, ranging from ₹500 to ₹10,000 for repair alone:
- Procedure Complexity: Second-degree (₹500–₹5,000); third/fourth-degree (₹5,000–₹10,000).
- Hospital/Location: Higher in metro cities (Apollo, Fortis; delivery + repair: ₹50,000–₹1.5 lakh); lower in government hospitals (AIIMS, ₹1,000–₹5,000).
- Surgeon’s Expertise: Experienced obstetricians charge more for complex repairs.
- Additional Costs: Anesthesia (if separate, ₹2,000–₹5,000), antibiotics, hospital stay (₹5,000–₹15,000/day).
- Insurance: Covered as part of vaginal delivery; confirm with your provider.
Episiotomy Repair Procedure
- Before Repair Assessment:
- Evaluation:
- Performed immediately after delivery, before or after placental expulsion.
- The extent of the incision/tear is assessed (e.g., midline or mediolateral episiotomy, degree of tear).
- Rectal exam: Rules out third/fourth-degree tears involving the anal sphincter or rectum.
- Medications: Local anesthesia (e.g., lidocaine) if not already under epidural; antibiotics if infection risk (e.g., third/fourth-degree tears).
- Consent: Usually part of delivery consent; risks (e.g., infection) explained.
- Evaluation:
- Surgical Techniques:
- Standard Repair:
- Performed in the delivery room, lasting 10–20 minutes.
- The patient is in the lithotomy position (legs in stirrups).
- Local anesthesia is injected if needed (epidural often sufficient from labor).
- The incision/tear is cleaned with antiseptic solution.
- Layered closure:
- Vaginal mucosa: Continuous or interrupted absorbable sutures (e.g., Vicryl) close the vaginal tissue.
- Perineal muscle: Interrupted sutures approximate the muscle layer.
- Skin: Subcuticular (under the skin) or interrupted sutures close the perineal skin.
- For third/fourth-degree tears: Anal sphincter and rectal mucosa are repaired first with fine sutures, often by an experienced obstetrician.
- Suture Materials:
- Absorbable sutures (e.g., Vicryl, chromic catgut) dissolve in 4–6 weeks; non-absorbable (rare) require removal.
- Intraoperative Care:
- Good lighting and exposure (e.g., with retractors) ensure proper repair.
- Hemostasis: Bleeding controlled during suturing.
- Standard Repair:
- After Repair:
- Observation: 1–2 hours in the delivery ward; hospital stay of 1–3 days (vaginal delivery).
- Pain management: Analgesics (e.g., ibuprofen, paracetamol) for 3–7 days.
- Antibiotics: For third/fourth-degree tears (e.g., cefazolin, metronidazole) to prevent infection.
- Hygiene instructions: Perineal care with warm water rinses; avoid wiping (pat dry) for 2 weeks.
- Ice packs: Applied for 24–48 hours to reduce swelling.
Recovery After Episiotomy Repair
- Hospital Stay: 1–3 days (part of vaginal delivery stay); longer (3–5 days) for third/fourth-degree tears.
- Post-Repair Care:
- Pain: Perineal discomfort for 1–2 weeks, managed with analgesics; worse with sitting/walking initially.
- Swelling: Peaks at 2–3 days, resolves in 1–2 weeks; ice packs help.
- Hygiene: Warm water rinses or sitz baths (2–3 times daily) for 1–2 weeks; pat dry to prevent infection.
- Activity: Avoid heavy lifting or straining for 2–4 weeks; walking encouraged to prevent clots.
- Bowel movements: Laxatives (e.g., lactulose) to avoid straining for 1–2 weeks (esp. third/fourth-degree tears).
- Intercourse: Avoid for 4–6 weeks until healed.
- Diet: High-fiber foods (e.g., fruits, vegetables) and 2–3 liters water daily to prevent constipation.
- Follow-Up:
- Visit at 1–2 weeks to check healing; 6 weeks for postpartum check-up.
- Monitor for infection or dehiscence (wound reopening).
Most resume normal activities in 2–4 weeks; full healing takes 4–6 weeks. Pain resolves in 90–95% of cases by 6 weeks; third/fourth-degree repairs may take longer (6–12 weeks).
Risks and Complications
- Immediate Risks:
- Infection (2–5%): Redness, swelling, or pus at the site; treated with antibiotics.
- Hematoma (1–2%): Blood collection causing swelling/pain; may need drainage.
- Dehiscence (1–3%): Wound reopening; requires resuturing or healing by secondary intention.
- Functional Complications:
- Painful intercourse (5–10%): Due to scarring; usually resolves by 3–6 months; pelvic floor therapy helps.
- Anal incontinence (third/fourth-degree, 5–10%): Improved with physiotherapy; 1–2% may need surgical repair.
- Long-Term:
- Perineal pain (2–5%): Chronic discomfort, often with mediolateral episiotomy or poor healing.
- Scar tissue (1–3%): May cause tightness; massage or surgery (rare) for severe cases.
- Fistula (rare, <1%): Abnormal connection (e.g., rectovaginal) with fourth-degree tears.
Report fever, severe pain, swelling, or fecal leakage promptly.
Frequently Asked Questions (FAQs)
Why is an episiotomy performed?
To facilitate delivery in cases of fetal distress, prolonged labor, or to prevent severe uncontrolled tears; now done selectively (10–20% of vaginal births).
Is episiotomy repair painful?
Not during repair (anesthesia used); perineal discomfort for 1–2 weeks post-repair, managed with medication.
Can I avoid an episiotomy?
Yes, 80–90% of vaginal births don’t need one; perineal massage, warm compresses, and controlled pushing reduce the need.
How soon can I resume activities?
Light activities (e.g., walking) immediately; normal routines in 2–4 weeks; intercourse after 4–6 weeks.
Is episiotomy repair covered by insurance in India?
Yes, as part of delivery costs; confirm with your provider.
Signs of complications?
Fever, severe pain, swelling, pus, or fecal leakage (third/fourth-degree tears).
Will I have a scar?
Yes, but usually minimal; visible scarring fades over 6–12 months; 1–3% may have tight or painful scars.
Lifestyle changes post-repair?
Maintain perineal hygiene, avoid straining, use sitz baths, delay intercourse for 4–6 weeks, and attend follow-ups.
Conclusion
Episiotomy repair is a standard procedure following an episiotomy or perineal tear during vaginal delivery, promoting healing and restoring function with a relatively quick recovery. India’s top hospitals (Apollo, Fortis, AIIMS) offer affordable, expert care. Understanding the procedure, costs, recovery, risks, and FAQs helps new mothers recover confidently. Consult an obstetrician for personalized guidance and optimal outcomes.
Looking for Best Hospitals for Episiotomy Repair
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we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)
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| City | Minimum Price (₹) | Maximum Price (₹) |
|---|---|---|
Agra |
10,000 |
45,000 |
Ahmedabad |
15,000 |
50,000 |
Ajmer |
10,000 |
45,000 |
Aligarh |
10,000 |
45,000 |
Allahabad |
10,000 |
45,000 |
Amritsar |
12,000 |
47,000 |
Aurangabad |
12,000 |
47,000 |
Bangalore |
15,000 |
50,000 |
Bareilly |
10,000 |
45,000 |
Belgaum |
12,000 |
47,000 |
Bhopal |
12,000 |
47,000 |
Bhubaneswar |
12,000 |
47,000 |
Bikaner |
10,000 |
45,000 |
Chandigarh |
15,000 |
50,000 |
Chennai |
15,000 |
50,000 |
Coimbatore |
15,000 |
50,000 |
Dehradun |
12,000 |
47,000 |
Delhi |
15,000 |
50,000 |
Dhanbad |
10,000 |
45,000 |
Durgapur |
10,000 |
45,000 |
Faridabad |
15,000 |
50,000 |
Ghaziabad |
15,000 |
50,000 |
Gorakhpur |
10,000 |
45,000 |
Guntur |
12,000 |
47,000 |
Gurgaon |
15,000 |
50,000 |
Guwahati |
12,000 |
47,000 |
Gwalior |
10,000 |
45,000 |
Hyderabad |
15,000 |
50,000 |
Indore |
12,000 |
47,000 |
Jabalpur |
10,000 |
45,000 |
Jaipur |
15,000 |
50,000 |
Jalandhar |
12,000 |
47,000 |
Jamshedpur |
12,000 |
47,000 |
Jodhpur |
10,000 |
45,000 |
Kanpur |
10,000 |
45,000 |
Kochi |
15,000 |
50,000 |
Kolkata |
15,000 |
50,000 |
Kollam |
12,000 |
47,000 |
Lucknow |
12,000 |
47,000 |
Ludhiana |
15,000 |
50,000 |
Madurai |
12,000 |
47,000 |
Mangalore |
12,000 |
47,000 |
Meerut |
10,000 |
45,000 |
Moradabad |
10,000 |
45,000 |
Mumbai |
15,000 |
50,000 |
Mysore |
15,000 |
50,000 |
Nagpur |
12,000 |
47,000 |
Nashik |
12,000 |
47,000 |
Navi Mumbai |
15,000 |
50,000 |
Noida |
15,000 |
50,000 |
Patna |
10,000 |
45,000 |
Pune |
15,000 |
50,000 |
Raipur |
12,000 |
47,000 |
Rajkot |
12,000 |
47,000 |
Ranchi |
10,000 |
45,000 |
Surat |
15,000 |
50,000 |
Thane |
15,000 |
50,000 |
Vadodara |
12,000 |
47,000 |
Varanasi |
10,000 |
45,000 |
Visakhapatnam |
12,000 |
47,000 |
Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.