Episiotomy

Episiotomy-About Episiotomy:

Episiotomy means to do an oblique incision in the perineum. The episiotomy includes not only lateral, can also be cut. Can prevent maternal perineal tear, to protect the pelvic floor muscles and surgical incision technique is easy to repair and heal better.

Episiotomy - the principle of
The area between the labia and the anus is the perineum. Usually only 2-3cm long, but production can stretch to about 10cm long. This is to help produce a smooth birth of the baby, the hormones will be overcast stretch. First childbirth, stretching the perineum is relatively difficult. Episiotomy means to do an oblique incision in the perineum. Includes not only the lateral episiotomy, can also be cut (For convenience, hereinafter collectively referred to as lateral). Can prevent maternal perineal tear, to protect the pelvic floor muscles and surgical incision technique is easy to repair and heal better.

Episiotomy - to adapt to the symptoms
Primiparous head position of the perineum during childbirth than the tight, long perineal body, the organization is hard and tough or dysplasia, inflammation, edema, or a case of acute intrapartum perineal failed to fully expand, it is estimated that when the fetal head grade Ⅱ or laceration.
A variety of reasons due to cephalopelvic disproportion.

Maternal had to make the perineal incision suture or scar patches, affecting the perineum expansion.
Forceps delivery, fetal head to attract midwifery or primiparous breech vaginal delivery.
Premature birth, intrauterine growth retardation or fetal distress and the need to reduce the fetal head compression and delivered as soon as possible.
Maternal suffering from diseases such as heart disease or high blood pressure need to shorten the second stage of labor to

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Episiotomy - the process ofCutCut timing
Physicians see when the fetal head quickly exposed to the vaginal opening, it will be the first time to judge the baby so big, will cause severe perineal tear, and then decide whether or not the purposes of episiotomy; production process very well, such as physician judgment , even if it does not cut the perineum, gaping wound is not large, it can avoid surgery.
Operating
Take the bladder lithotomy position, and bilateral pudendal nerve block anesthesia, when the contractions in his left hand index finger depth to hold up the left wall of the vagina vagina, since the perineum after the joint midline episiotomy cut to the left direction of 45 ° cut the perineum. Such as the perineum of a high degree of bulging, the cut angle of 60 ° to 70 °, so as not to damage the rectum. The incision is generally 4 ~ 5cm, cut after the application of gauze to stop bleeding, if necessary, clamp hemostasis.
Time
Does not need to take the time to cut slowly, but rapid moments medical scissors cut the length of the incision is only about 2-5cm, I feel really is the "moment". In the throes of a more serious, and even some mothers do not know to have been cut.
The degree of pain
Cut is in the throes of the peak, so basically do not feel the episiotomy. In addition, because the role of local anesthesia, the incision when the fears of the pain is completely not necessary.
SutureFetal give birth, you can repair surgery.
Operating
Anatomical level, sutured, the suture before the 0.2% metronidazole solution to wash the incision of the perineum, vagina internal gauze, 0.5 ~ 1.0cm from the incision on the top row with 0 chromic catgut suture the vaginal mucosa to the hymen The inner ring at the knot, the deep part of the submucosal tissue, the same gut was sutured muscular layer, to stop the bleeding and close the dead space for the purpose of. Similarly, the gut was sutured subcutaneous adipose tissue, and finally with 00 chromic catgut continuous intradermal suture. Skin closure, since the incision top of about 1.0cm at the needle knot, and then down along the incision the left side of the skin edge of the needle at the peak of 0.2cm at the needle the same stitch length along the right side out of the needle, and the left side of symmetry , that is "U" shaped suture. Vertices on both sides of the skin flap to fit tightly, and then along both sides of the skin flap stitch length of about 0.5cm continuous intradermal suture to the outer ring of the hymen at knot. The suture end, routine vaginal examination, remove the gauze and the residue gauze, 0.2% metronidazole solution-soaked gauze wound. This group of 520 patients with routine episiotomy incision are Grade healing.
Time
Takes about 20 minutes. Of course, according to the depth of the wound and the doctor, time, how much is there will be some differences. Lateral when the local anesthetic effect also affected the pain when the suture is not very strong.
Sutures
Used previously is the need to remove the "line can not be dissolved, and are generally the use of synthetic absorbable sutures that" line can be dissolved. Synthetic line over a period of time, will be absorbed by the body and sound. A short time there will be discomfort, the discomfort will disappear after a certain period of time.

Episiotomy - pain time
, Depending on the individual circumstances, it was only pain for a few days, someone up to one month, if the incision is larger can damage the inside of the muscle tissue, so the pain will last a long time. A month later, to feel pain, it is necessary to find a medical examination to see if there is a bacterial infection and other issues.

Episiotomy - Nursing
Many mothers believe that the lateral can be tolerated, but 1 - 2 weeks after surgery is the most difficult. Of course, eating painkillers are the most direct way to relieve pain, but you can also take some physical therapy to allow the wound to recover as soon as possible:

After using the toilet flush: women produce finished toilet water should wash the perineum, like the use of toilet paper to wipe from front to back flush, in order to avoid bacterial infection.
With tissue paper to keep the wound dry: toilet, bath, pat the perineum, to keep the wound dry and clean.
Never force: Do not force the solution will be to mend the wound and then split.
Do heavy lifting: a postpartum months, not lifting heavy objects, do not do any taxing housework and exercise.
Avoid sexual activity: 6 weeks postpartum, you should avoid sexual behavior.
Excellent Code of swelling can be used: the more serious laceration and wound swelling and pain, can povidone iodine added to the water bath, or heat lamp to speed up the recovery speed. (Povidone iodine for sterilization, warm water and a heat lamp while the high temperature to promote blood circulation)

 

Episiotomy - methods to avoid
The doctor decided to adopt a lateral, a large part of the reason is to avoid maternal perineal tear. At this point, some of the practices of the foreign mother that we can learn, they are usually about 32 weeks of pregnancy, every day started perineal massage and exercise to increase the flexibility and elasticity of muscle tissue, the specific operation is of:

Nails, wash your hands, sitting in a warm and comfortable place to stretch your legs open, showing a half-sitting delivery posture.

A mirror placed in front of the perineum, facing the perineum. So you can clearly see the surrounding muscle tissue in the perineum.

Select some massage oil, such as pure rapeseed oil, or water-soluble lubricant, massage oil is applied to the perineum around with your thumb and fingers.

Your thumb as deeply as possible into your vagina to stretch his legs. The direction of the rectum to press the the perineum organization. Gently continue to stretch the perineum mouth until you feel some slight burning or tingling sensation.

Maintain this stretch until the tingling sensation subside, then continue around the gentle massage of the vagina.

Massage which evoke your thumb in the vagina, and slowly toward the front stretch the vaginal tissue, childbirth when the baby's head will be out.

Finally, before and after gentle massage of the muscle tissue between the thumb and index finger about 1 minute.

Note:

Too hard can cause sensitive skin of the perineal bruising and tingling.

Do not press hard on the urethra during the massage, as this would lead to infection and inflammation.

Exercise sphincter

Tighten the muscles of the vagina and anus, every day is almost done 200 times, every 8 - 10 seconds. You can also try to pause in the urine when the muscle contraction.

Sphincter exercise more benefits:

Can help you no longer leak urine when you sneeze or cough.

Good toughness of the muscle can make childbirth easier, and the perineum will remain intact (less tear and the use of incision surgery smaller chance). The sweetness of two of the world to enjoy sex also help. Because it will prevent pelvic organ prolapse and aging

 

Episiotomy - hazards
Not authoritative survey lateral maternal causing the injury. Almost all of the lateral by perennial itching sense, more than 85% of the lateral that affect the sex life, there are a considerable number of people infected with the disease, and even perennial refractory. Physical weak or inadequately treated, lives worrying.

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