Definition: The making of an incision into the prenium to enlarge the vaginal orifice.
· Delay due to rigid perineum, disproportion between fetus and vaginal orifice.
· Fetal distress due to prolapsed cord in second stage.
· To facilitate vaginal or intra uterine manipulation Eg. Forceps, breach delivery
· Preterm baby in order to avoid intracranial damage
· Previous 3rd degree repaired on the perineum.
· Fetal acidosis and hypoxia are reduced
· Over stretching of the pelvic floor is lessened
· Bruising of the urethra is avoided.
· In sever pre – eclampsia or cardiac disease to reduce the effort bearing down.
· A previous third degree tear which may occur again because of the scar tissue which does not stretch well is prevented.
· Medio- lateral
· J- shaped
1. Medio – lateral
The incision is begun in the center of the fourchette and directed posterio laterally, usually to the woman’s right. Not more than 3cm long & directed diagonally in straight line which runs 2.5cm distance from the anus. Advantages - barthlion glands are not affected
Anal sphincters are not injured
2. Median: The incision begun in the center of thefourchette and directed posteriorly for approximately 2.5cm in the midline of the prenium.
· Less bleeding
· More easily and successfully repaired
· Greater subsequent comfort for the women
3. J – shaped : The incision is began in the center or thefourchtte and directed posteriorly in the midline for about 2cm and then directed towards 7 on the clock to avoid the anus. Disadvantage
- The suturing is difficult
- Shearing of the tissue occurs
- The repaired wound tends to be pucked.
4. Lateral: The incision is begun one or more in distant fromthe condomned.
· Bartholins duct may be served
· The levatorani muscle is weakened
· Bleeding is more profuse
· Suturing is more difficult
· The woman experiences subsequent discomfort
Lignocaine /lidocaine/ 0.5 percent of 10ml is safe and efficient.
It takes effect rapidly with in 1 & 2 minutes.
· The head should be well down on the perineum, low enough to keep it stretched and thinned
· In breech presentation the posterior buttock would be distending the perineum
· It must be made neither too soon nor too late
· Avoid incision on the previous episiotomy scar
· Not more than 3 cm from fourchette and 2.5 cm from anus
· Position the mother in lithotomy
· Wait one or two minutes after injection of local anesthesia
· Insert two flingers between the perineum with the fetal scalp
· Do the incision during a uterine contraction
· It should be deliberate cut
· The cut should be adequate to remove any resistance to fetal head
· May straight blunt painted scissors 17.5cm commonly used.
· Must be sharpened at frequent intervals
· Should be sutured with in one hour after local analgesia given
· The area is cleansed with savalon solution
· For any leakage from the uterus, vaginal tampon or pack should be inserted
· Good light is essential
· The two extent of the laceration is determined
· Applying gauze swab on the area
· The pressure exerted by the fetal head
· If bleeding occurs after delivery – two Spencer wells forceps should be applied to the bleeding vessels.
· Vaginal wound
o Deep and superficial tissue
o Vaginal mucosa
· Perineal muscles and fascia
· Perineal skin and subcutaneous tissue
The first stitch inserted at the apex of the incision The most commonly used suturing material is 2/0 chromic catgut.
· Do not tie the sutures too tightly
· The last stitches are important for they prevent excessive scar.
· Press firmly on suture line with a pad to see if bleeding has stopped.
· Remove perineal pad or suture pack from vagina. Rub up fundus put clean pad on perineum
· Put gloved finger in to the rectum – to make suture that no stitch has one through the rectum
· Make the women comfortable, clean and dry.
· Hot bath, clean wound care
· If pus or fouls smelling discharge develop report to health personnel
· Advise not to strain and avoid constipation
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