Obstetrics and Gynecology - A.M. Hromova 2000
Operative Obstetrics
Operations Preparing the Birth Canal
Perineotomy
Surgical Procedures involving the incision of the Perineum include Episiotomy and perineotomy. These operations are performed to prevent perineal tears, protect the fetal HEAD from trauma, and shorten the Second Stage of labor.
Indications:
1. Threatened or early signs of perineal tearing (clean-cut surgical edges heal much faster than jagged lacerations).
2. Fetal Hypoxia, uterine inertia when the fetal head is stationed at the pelvic outlet.
3. Premature birth (perineotomy reduces compression of the fetal head by the perineal Muscles).
4. Abnormal perineal conditions (high perineum, scarring, or a rigid perineum).
Surgical technique. The external genitalia are prepped with a 5% iodine solution. Between contractions, a blade of blunt-pointed scissors is inserted between the fetal presenting part and the vaginal wall along the intended line of incision. The incision is made at the peak of a contraction. Its length and depth should be at least 2 cm.
In episiotomy, the incision is made 2–3 cm above the posterior fourchette toward the ischial tuberosity.
In perineotomy, the incision is performed from the posterior fourchette toward the anus. Its length should not exceed 3–3.5 cm, as a longer incision may result in a third-degree perineal tear.
1. Name the procedures used to prepare the birth canal.
2. Define Amniotomy.
3. What are the indications for amniotomy?
4. Describe the technique of amniotomy.
5. In which cases is cervical dilation performed?
6. What Methods are used for cervical dilation?
7. Describe the technique of these procedures.
8. Define episiotomy and perineotomy.
9. What are the indications for a perineal incision?
10. Describe the surgical techniques for episiotomy and perineotomy.
Last update: 08/08/2026
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