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Episiotomy or vaginal repair, by other than attending
CPT4 code
Name of the Procedure:
Episiotomy or Vaginal Repair, by Other than Attending
Summary
An episiotomy is a surgical cut made at the opening of the vagina during childbirth, to aid a difficult delivery and prevent tissue rupture. Vaginal repair involves stitching any tears or an episiotomy that occurred during delivery.
Purpose
The primary goal is to facilitate a smoother delivery and to repair any tears or cuts to prevent complications such as excessive bleeding, infection, or long-term dysfunction.
Indications
- Prolonged labor
- Large baby size
- Breech (bottom-first) delivery
- Use of instruments like forceps or vacuum
- Tears resulting from childbirth
Preparation
- Pre-assessment and consent
- Potential fasting if using specific anesthesia
- Discussing pain management options
- No significant food, drink, or medication restrictions typically required
Procedure Description
- Episiotomy:
- Administer local anesthesia
- A sterile cut is made in the perineal tissue
- Vaginal Repair:
- Clean the area
- Stitch the cut or tear with absorbable sutures
- Apply antiseptic to prevent infection
Equipment used includes surgical scissors, sutures, needles, and a needle holder. Local anesthesia is commonly used.
Duration
The procedure typically takes about 15-30 minutes.
Setting
Hospital labor and delivery room or outpatient surgical center.
Personnel
- Obstetrician or gynecologist
- Attending nurse
- Possible anesthesiologist for specific cases
Risks and Complications
- Infection
- Bleeding
- Pain or discomfort
- Scar tissue formation
- Painful intercourse
- Rare: Prolapse or urinary incontinence
Benefits
- Facilitates safer, quicker delivery
- Reduces risk of severe tearing
- Promotes quicker healing of tissue
Recovery
- Administer pain relief as needed
- Keep the area clean and dry
- Avoid heavy lifting and vigorous activities
- Recovery time is typically 4-6 weeks
- Follow-up appointments to monitor healing
Alternatives
- Natural tearing without intervention
- Perineal massage to prepare for delivery
- Non-surgical methods for managing labor Pros and cons vary: Natural tearing may heal better but pose higher risk of severe tears.
Patient Experience
During:
- Local anesthesia prevents pain, but pressure may be felt
After:
- Mild to moderate pain managed with medications
- Discomfort during urination or sitting Comfort measures include cold packs, sitz baths, and prescribed pain relievers.