Perineal tears are one of the most frequent complications of childbirth, they occur in about 35% of pregnant women, and in nulliparous
- nulliparous older age (after 30 years) decreases the elasticity of the soft tissues;
scar-modifiedperineum after previous birth;
- rapid and accelerated labor;
- extensor insertion of the fetal head (head not inserting the smallest size);
- breech presentation;
- large fruit;
- improper provide obstetrical care (methods of protection of the perineum, and the shoulder of the launch, etc.)
- surgical interventions in childbirth — forceps,
vacuum extractionfruit, extracting the fetus pelvic end, manual removal of the placenta, etc.
What's going on?
Perineal trauma preceded by warning signs about the threat of rupture — a significant bulging crotch, her cyanosis due to venous stasis. In the future, there is a swelling of the tissue, the skin takes a special shine. If no action is taken, there is an infringement of blood circulation, the skin becomes pale crotch. At first it may crack and then is gap.
If there are signs of danger perineal to avoid injury, make itsection— Perineotomy or episiotomy.
Episiotomy — cut from the crotch to the side, perineotomy — section towards anus. The incision of the perineum is conducted only for the following indications:
- the threat of rupture of the perineum;
- acute hypoxia (excessive increase in the fetal heart, green water);
- breech delivery — to reduce the likelihood of injury to the head, which is the last;
- premature birth — to facilitate the birth of a premature baby (high probability of injury to the fetus during labor).
When perineal sutures. Typically, small tears sutured under local anesthesia, with extensive recourse to general anesthesia. As a rule, use catgut and silk thread.
Postoperatively, the surface seams should be kept clean. Area seams rubbed with sterile swabs and treated with a solution of potassium permanganate or tincture of iodine. Toilet perineum is carried out after each act of urination or defecation. On the 5th day after surgery Parturient give drink saline laxative, and on day 6 after chair silk sutures removed from the skin of the perineum.
The recovery period is from 1 to