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    Perineal Care

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    Poetri Iermayani
    This document discusses perineal care following vaginal delivery. It describes that vaginal delivery can cause perineal injuries ranging from first degree tears of the skin or vaginal wall to fourth degree tears involving the rectal mucosa. More extensive third and fourth degree tears are associated with risks of incontinence or fistula. Following delivery, the perineum should be examined to identify any injuries and their extent in order to guide appropriate repair. Episiotomy is a surgical incision that can prevent jagged tearing but does not reduce risks of serious tears and is not routinely recommended for spontaneous deliveries. First and second degree perineal tears identified after delivery should be repaired through suturing to aid healing.

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    Perineal Care

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    Poetri Iermayani
    3 views3 pages
    This document discusses perineal care following vaginal delivery. It describes that vaginal delivery can cause perineal injuries ranging from first degree tears of the skin or vaginal wall to fourth degree tears involving the rectal mucosa. More extensive third and fourth degree tears are associated with risks of incontinence or fistula. Following delivery, the perineum should be examined to identify any injuries and their extent in order to guide appropriate repair. Episiotomy is a surgical incision that can prevent jagged tearing but does not reduce risks of serious tears and is not routinely recommended for spontaneous deliveries. First and second degree perineal tears identified after delivery should be repaired through suturing to aid healing.

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    This document discusses perineal care following vaginal delivery. It describes that vaginal delivery can cause perineal injuries ranging from first degree tears of the skin or vaginal wall to fourth degree tears involving the rectal mucosa. More extensive third and fourth degree tears are associated with risks of incontinence or fistula. Following delivery, the perineum should be examined to identify any injuries and their extent in order to guide appropriate repair. Episiotomy is a surgical incision that can prevent jagged tearing but does not reduce risks of serious tears and is not routinely recommended for spontaneous deliveries. First and second degree perineal tears identified after delivery should be repaired through suturing to aid healing.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    3 views3 pages

    Perineal Care

    Uploaded by

    Poetri Iermayani
    This document discusses perineal care following vaginal delivery. It describes that vaginal delivery can cause perineal injuries ranging from first degree tears of the skin or vaginal wall to fourth degree tears involving the rectal mucosa. More extensive third and fourth degree tears are associated with risks of incontinence or fistula. Following delivery, the perineum should be examined to identify any injuries and their extent in order to guide appropriate repair. Episiotomy is a surgical incision that can prevent jagged tearing but does not reduce risks of serious tears and is not routinely recommended for spontaneous deliveries. First and second degree perineal tears identified after delivery should be repaired through suturing to aid healing.

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    PERINEALCARE

    Vaginaldeliveryisassociatedwithariskofperinealinjuryandshort/longtermperinealpain
    includingdyspareunia

    Themajorityofperinealinjuriesarefirstdegree(injurytothevaginalwallorperinealskin
    only)orseconddegree(injurytothevaginalwall/perinealskinandperinealmuscle)

    Thirddegreetearsinvolvetheanalsphincterwhilefourthdegreetearsinvolvetherectal
    mucosa.Buttonholetearsinvolvetherectalmucosabutnottheanalsphincter.

    Thirdandfourthdegreetearsareassociatedwithariskofincontinenceorfistulaformation.

    Careshouldbetakentominimisetheriskofperinealinjuryandtoclearlyidentifythenature
    andextentofanyinjurysoappropriaterepaircanbeundertaken.

    Perinealmassageorlocalanaestheticsprayshouldnotbeused.

    Eitherthehandson(guardingtheperineumandflexingthebabyshead)orthehandspoised
    (withhandsofftheperineumandbabysheadbutinreadiness)techniquecanbeusedduring
    spontaneousdelivery

    Episiotomy

    AnEpisiotomyisanincisionintheperineumtowidentheintroitusandfacilitatedeliveryofthe
    fetusorpreventjaggedtearing

    Episiotomyisasurgicalprocedureandshouldbeundertakenwithappropriatepreparation
    includinginformedconsent,adequateanalgesiaanddueregardtosterilityandasepsisexceptin
    anacuteemergency.

    Episiotomydoesnotreducetheriskofthirdandfourthdegreetearsandroutineepisiotomy
    shouldnotbeperformedduringspontaneousdelivery.

    Routineepisiotomyshouldnotbeofferedtowomenwithapreviousthirdorfourthdegreetear

    Whereanepisiotomyisperformed,therecommendedtechniqueisamediolateralepisiotomy
    originatingatthefourchetteandusuallydirectedtotheright.Theangletotheverticalaxis
    shouldbe4560degrees

    Managingperinealtrauma

    Examination

    Followingdelivery,athoroughexaminationoftheperineumshouldbeundertakentoidentify
    anyinjury

    1)Explainthepurposeoftheexaminationandobtaininformedconsent
    2)Ensureadequateanalgesia/offerinhalationanalgesia
    3)Ensuregoodlighting
    4)Ifanyinjuryisidentified,amoredetailedassessmentisrequired(includingrectalexamination
    afterinformedconsent)toidentifythenatureandextentoftheinjury.Additionalanalgesiamaybe
    requiredforsuchassessmentandthewomanwillneedtobeplacedinlithotomy
    5)Examinationoftheperineumshouldnotinterferewiththewomansinteractionwithherbaby
    unlessthereisbleedingthatrequiresattention

    Perinealrepair(first&seconddegree)

    Repairofperinealtraumaisasurgicalprocedureandshouldonlybeundertakenby
    appropriatelytrainedcliniciansorundersupervisionandfollowinginformedconsent
    Thewomanshouldhaveadequateanalgesiaandanaseptictechniqueshouldbeused
    Repairshouldoccurassoonaspossibletominimizetheriskofinfectionandbleeding
    Firstdegreetearsshouldbesuturedinordertoimprovehealingunlesstheskinedgesarewell
    opposed.
    Inseconddegreetears,themuscleshouldbesuturedinordertoimprovehealing.Iftheskinis
    opposedfollowingsuturingofthemuscle,thereisnoneedtosutureit.
    Theskinshouldbesuturedusingacontinuoussubcuticulartechnique.
    Acontinuousnonlockingtechniqueshouldbeusedforthevaginalwallandmusclelayers
    Absorbablesyntheticsuturematerialshouldbeusedtosuturetheperineum
    Rectalnonsteroidalantiinflammatorydrugsshouldbeofferedfollowingrepairoffirstand
    seconddegreetrauma
    Rectalexaminationshouldbecarriedoutaftercompletingtherepairtoensurethatsuture
    materialhasnotbeenaccidentallyinsertedthroughtherectalmucosa
    Followingcompletionoftherepair,anaccuratedetailedaccountshouldbedocumented
    coveringtheextentofthetrauma,themethodofrepairandthematerialsused
    Informationshouldbegiventothewomanregardingtheextentofthetrauma,painrelief,diet,
    hygieneandtheimportanceofpelvicfloorexercises.

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