Orris

Infected episiotomy gape management

Reading File
Finding Sources
Finding Sources
Searching PubMed

episiotomy AND wound infection

Searching the Web

postpartum perineal wound breakdown infection episiotomy management guideline

Reading File
Reading File
Reading Web Page

https://www.rcog.org.uk/for-the-public/perineal-tears-and-ep…

Infected episiotomy wound gape (perineal wound dehiscence): management

This needs prompt obstetric or gynecology assessment today. An infected open episiotomy should not be managed by simply closing it at home or immediately re-suturing it.

1. Assess severity and exclude emergencies

Examine the wound for:
  • Extent/depth of separation, necrosis, pus, cellulitis, hematoma
  • Fever, tachycardia, systemic illness
  • Severe or escalating pain, swelling, foul discharge
  • Involvement of anal sphincter/rectum, urinary symptoms, fecal or flatus incontinence
Urgent hospital assessment is needed for fever, feeling very unwell, rapidly spreading redness/swelling, severe pain out of proportion, skin discoloration/blisters, heavy bleeding, or inability to pass urine. These can indicate deep infection, hematoma, or rarely necrotizing soft-tissue infection. Creasy & Resnik’s Maternal-Fetal Medicine, pp. 1132-33.

2. Initial local management

By a trained clinician:
  • Inspect under adequate analgesia and lighting.
  • Take a wound swab/culture if discharge or infection is present.
  • Open/drain if necessary, explore the wound, evacuate any infected collection or hematoma, and remove devitalized tissue by debridement.
  • Check for extension into the anal sphincter or rectal mucosa, particularly in a deep gape or after a third/fourth-degree tear.
A localized infection with erythema, edema, and exudate is treated by opening, exploration, and debridement as required. Creasy & Resnik’s Maternal-Fetal Medicine, p. 1132.

3. Antibiotics and analgesia

  • Start antibiotics with aerobic and anaerobic coverage according to local postpartum-perineal infection guidelines, then tailor to culture results and clinical response.
  • If systemically unwell, suspected deep infection, or unable to take oral medication, admit for IV antibiotics and surgical review.
  • Use appropriate pain relief. Paracetamol and ibuprofen are generally compatible with breastfeeding when not otherwise contraindicated.
Do not self-start leftover antibiotics, because the appropriate choice depends on severity, allergy history, local resistance patterns, and whether deeper infection is suspected.

4. Do not re-suture while infection is active

An infected gaping wound is generally left open after cleaning and drainage to heal by secondary intention. Immediate closure can trap infection and infected tissues do not hold sutures well. RCOG guidance also advises against re-suturing in the presence of infection.

5. Delayed re-suturing

Once infection has resolved and the wound bed is clean, healthy, and granulating:
  • Many wounds heal satisfactorily without further surgery.
  • For a large/deep symptomatic defect or delayed healing, delayed secondary repair can be considered by an experienced obstetric/gynecology team, often after about a week or more of wound care once tissue appears healthy.
  • If the external anal sphincter or rectal mucosa is involved, repair should wait until the infection is cleared and should be done by a specialist team. Creasy & Resnik’s Maternal-Fetal Medicine, p. 1132.

6. Home care while awaiting review or during healing

  • Keep the area clean and dry. Rinse with plain water, then pat dry or air dry.
  • Avoid soaps, shower gels, antiseptics, powders, creams, and oils directly on the wound unless prescribed.
  • Change sanitary pads frequently and wash hands before/after pad changes.
  • Maintain fluids, fiber, and stool-softening measures if prescribed, to avoid straining.
  • Attend planned wound reviews. Granulation tissue can sometimes cause persistent spotting or pain and may need outpatient treatment.

Key principle

Infection first: drain/debride when indicated, give appropriate antibiotics, allow healing or perform delayed repair after the infection has resolved. Do not re-suture an actively infected episiotomy gape.
A recent systematic review found inconsistent definitions and reporting of episiotomy/second-degree tear infection and dehiscence, so management should be guided by clinical severity rather than the size of the visible gap alone (Perslev et al., 2026, PMID 41148318).
This is a shared conversation. Sign in to Orris to start your own chat.