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    Perinial Tear Session Four

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    Perinial Tear Session Four

    Uploaded by

    said98omary
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    © All Rights Reserved
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    Download as pptx, pdf, or txt
    4 views25 pages

    Perinial Tear Session Four

    Uploaded by

    said98omary

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 25

    CARE OF A WOMAN WITH PERINEAL

    TEAR AND EPISIOTOMY


    Prerequisites
    • Module 7: NMT 05107 Care of a woman
    during antenatal period
    by MADAM SUBIRA
    Learning Outcomes

    At the end of this session participants are


    expected to be able:
    • Define perineal tear
    • Classification of perineal tear
    • Risk factors for perineal tear
    • Care of a woman with perineal tear
    • Care of the woman with episiotomy
    • Complications of perineal tear and episiotomy
    Definition of PerinealTear

    • Perineal tear /laceration


    • Is the trauma of the perineum that occurs
    during delivery
    – The perineum is the region between the vaginal
    opening and the anus.
    – The perineum may be injured when there is
    overstretching or over-distension during delivery
    Classification of Perineal tear

    • First degree tear


    – laceration is limited to the fourchette and superficial
    perineal skin or vaginal mucosa
    • Second degree tear
    – Injury to perineum involving perineal body (muscles)
    but not involving the anal sphincter.
    • Third degree tear
    • Injury to perineum, involving the anal sphincter
    complex (both external and internal
    • Fourth degree tear
    – Injury to perineum involving the anal sphincter
    complex (External and internal anal sphincter) and
    anal epithelium.
    Risk Factors for Perineal tear

    The risk factors for perineal tear includes


    • Big babies
    • Malpresentation/malposition
    • Narrow vaginal outlet
    • Shoulder dystocia
    • Instrumental vaginal delivery
    • Precipitate labour
    • Scar in perineum
    • Midline episiotomy
    Care of a Woman with Perineal Tear

    • Repairing perineal tear


    • Trauma is best repaired as soon as possible
    after birth in order to secure haemostasis and
    before oedema forms
    • Ensure the mother is warm and comfortable
    as possible
    Prepare the appropriate instruments including

    – Surgical gloves
    – Needle holder
    – Suture material
    – Antiseptic solution
    – Local anaesthetic
    – Dissecting forceps
    – Stitching scissors
    – Sterile gauze
    – Kidney dish
    – Two galipots
    • Place the mother in lithotomy position
    • Then assess the extent of the tear
    • First degree tear
    – Most first degree tears close spontaneously
    without sutures
    • Second degree tear
    – Apply antiseptic solution to the area around the te
    ar
    .
    CONT…
    – Infiltrate local anaesthesia beneath the vaginal
    mucosa, beneath the skin of the perineum and
    deeply into the perineal muscle
    – Repair the vaginal mucosa using a continuous 2-0
    suture
    – Start the repair about 1 cm above the apex (top)
    of the vaginal tear.
    – Continue the suture to the level of the vaginal
    opening
    • For third and fourth degree tear
    _These tears should be repaired in the theatre
    • Care after repair
    – Instruct the patient to clean the wound using
    antiseptic after urination and defecation
    – Give the woman analgesics to relieve pain
    – Give the woman broad spectrum antibiotics
    – Instruct the woman not to use hot water on the
    wound.
    Care of a Woman with Episiotomy

    Episiotomy
    – Is a surgically planned incision on the perineum and the posterior vaginal
    wall during the second stage of labor
    • Indications of episiotomy
    _In elastic (rigid) perineum:
    – Causing arrest or delay in descent of the presenting part as in elderly
    primigravidae
    • Anticipating perineal tear due to the following
    – Big baby
    – Face to pubis delivery
    – Breech delivery
    – Shoulder dystocia.
    • Operative delivery:
    – Forceps delivery, ventouse delivery.
    • Previous perineal surgery
    • Types of episiotomy
    •
    • Medio-lateral
    – The incision is made downward and outward from
    midpoint of fourchette either to right or left.
    – It is directed diagonally in straight line which runs about
    2.5 cm away from the anus (midpoint between anus and
    ischial tuberosity).
    • Median
    – The incision commences from center of the fourchette and
    extends on posterios side along midline for 2.5 cm.
    • Lateral
    – The incision starts from about 1 cm away from
    the center of fourchette and extends laterally.
    • 'J' shaped
    – The incision begins in the center of the fourchette
    and is directed posteriorly along midline for about
    1.5 cm and then directed downwards and
    outwards along 5 or 7 o'clock position to avoid the
    anal sphincter. This is also not done widely.
    Making an incision

    • A straight bladed, blunt ended pair of Mayo scissors


    is usually used.
    • The blade should be sharp.
    • Two fingers are inserted into the vagina and open
    the blades are positioned.
    • The incision is best made during contractions when
    the tissues are stretched so that there is a clear view
    of the area and bleeding is less likely to be severe.
    • A single deliberate cut 4-5 cm long is made at the
    correct angle
    CONT…
    • Birth of the head should follow immediately and its
    advance must be controlled in order to avoid
    extension of the episiotomy.
    • If there is any delay before the head is emerging,
    pressure should be applied to the episiotomy
    between the contractions in order to minimize
    bleeding.
    • Post partum bleeding can occurfrom an episiotomy
    site unless bleeding points are compressed
    Care of a woman with episiotomy

    • The care is the same as in perineal tear


    Complication of Episiotomy and Perineal
    Tear

    • Increased long-term discomfort eg


    dyspareunia, chronic perineal pain,
    • Infection.
    • Hematoma formation
    • Fecal or gas incontinency
    Key Points

    • Perineal tear is the trauma of the perineum that


    occurs during delivery
    – The perineum is the region between the vaginal
    opening and the anus.
    – The perineum may be injured when there is
    overstretching or over-distension during delivery
    • Episiotomy
    – Is a surgically planned incision on the perineum and the
    posterior vaginal wall during the second stage of labor
    Session Evaluation

    • What are the indications of episiotomy?


    • What are the complications of episiotomy and
    perineal tear?
    References

    • Bennett, V. R., & Brown, L. K. (1999).Myles’ textbook for midwives (13thed.). London:
    Churchill Livingston.
    • Dutta, D. C. (2004).Text Book of Obstetrics: Including Perinatology and Contraception. New
    central book agency.
    • Fraser, D. M., Cooper, M. A., & Fletcher, G. (2003).Myles’ textbook for midwives
    14thed.).London: Churchill Livingston.
    • Fraser, D. M., & Cooper, M. A. (2009).Myles’ textbook for midwives (15thed.). London:
    Churchill Livingston.
    • John,N.K,& Bacchus ,M.Y.(2010).Gyanaecology and family planning(2 nded).Daees salaam.
    • Varney H., (2004). Varney’s Midwifery text book 4th edition massarchusets, Tones &Bartelt
    Pg 666-667
    •
    •
    •
    •
    •
    • END…

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