Obstetrics and Gynecology - A. M. Gromova 2000

Operative Obstetrics
Operations Preparing the Birth Canal
Episiotomy

Surgical Procedures involving 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. Imminent or early signs of perineal rupture (clean-cut surgical edges heal much faster than jagged lacerations).

2. Fetal Hypoxia, uterine inertia, when the fetal head is arrested in the pelvic outlet plane.

3. Premature birth (perineotomy reduces the compression of the fetal head by the perineal Muscles).

4. Abnormal perineal conditions (high perineum, scarred Tissues, rigid perineum).

Surgical technique. The external genitalia are prepped with a 5% iodine solution. During an interval between contractions, the 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 uterine contraction. Its length and depth should be at least 2 cm.

In episiotomy, the incision is made 2–3 cm above the posterior fourchette directed toward the ischial tuberosity.

In perineotomy, the incision is made from the posterior fourchette toward the anus. Its length should not exceed 3–3.5 cm, as a longer incision may extend into a third-degree perineal tear.

Control questions:

1. Name the procedures used to prepare the birth canal.

2. Define Amniotomy.

3. State the indications for amniotomy.

4. Technique of amniotomy.

5. In what cases is cervical dilation performed?

6. What Methods are used for cervical dilation?

7. Technique of their execution.

8. Define episiotomy and perineotomy.

9. State the indications for perineal incision.

10. Technique of episiotomy and perineotomy.