# Perineal Repair

## Overview

This module describes how to repair an episiotomy or a first or second degree perineal tear postpartum. Third and fourth degree repairs are often repaired in theatre.

## Indications

## Contraindications

## Patient information and consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“You have a cut or tear in your vagina after you gave birth. I need to put a few stitches in so that it will heal well.”

### What can my patient expect?

“I am going to give you an injection that will prevent you from feeling pain, but it will sting a little. Then I will put in the stitches. The stitches will dissolve by themselves while the wound is healing, so you don’t have to have them taken out.”

### What is my patient’s role?

“Let me know if you have any allergies. Let me know if anything is painful, and let me know if you feel faint while I put in the stitches. When you go home, keep your stitches clean and dry. You can sit in a bath of cool water for up to 20 minutes at a time to help ease the pain. Wait for 6 weeks before resuming sexual intercourse. If the wound becomes more painful, appears to be gaping open, or has a discharge, go for a wound check. Do not pull at the stitches.”

## Preparation

Prepare a trolley with equipment. Ensure a female chaperone is present. Ensure you have adequate lighting—general ward lighting is not enough.

### Documentation

### Equipment

## Site & Positioning

Position the patient in lithotomy.

## Procedure

Follow medical asepsis with sterile gloves; however, due to the nature of vaginal tears, complete sterility may not always be achievable.

## Troubleshooting

My needle is bending and losing its curve as I suture through the tough perineal skin.

Make sure you are using a thick enough needle and that you are using a wrist motion that follows the curve of the needle. Good lighting helps with your technique. Losing the curve of your needle makes it harder to put in the next stitch and could result in the tip breaking off. If this happens, contact a senior for help.

## Risks

## References