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MDWF 2090 Carter 8
MDWF 2090 Carter 8
Complete a thorough exam and assessment. Plan the repair. Always start with the deepest, most
internal, hard-to-reach damage. In the event of a cervical tear, internal, and external anal
sphincters, transfer for complete repair.
Anchor Stitch
Placed 1 cm above the internal apex of the tear to ligate any retracted blood vessels (helps
prevent hematomas)
If tear is not bleeding and the upper end is hard to reach, it is acceptable to place this
stitch less than 1 cm above the apex.
o Never guess the location of the internal apex of a tear; it must be accurately
identified before you proceed with the repair.
Tie the anchor stitch using a surgical knot
Constructed with:
o 3 throws for chromic
o 4 for braided synthetic
o Trim only free end
Check to confirm knot is secure against the tissue and slightly moveable
Anchor stitch should not pucker on either side of tissue
Use 3-0 chromic gut or 2-0 braided synthetic on a CT-1 or T-12 taper point needle for
most repairs
For shallow tears, a small taper point needle (SH or T-5) is sufficient
Use 2-0 multifilament synthetic if the introitus requires repair or reconstruction
Shallow stitch
o Use a smaller half circle needle
Large, deep stitch
o Use heavier suture
o Muscles tend to pull away from the midline
o Stronger suture material needed to ensure edges stay together under stress.
o You can use 2-0 chromic gut or 1-0 absorbable synthetic swagged to a standard
(CT-1, T-12) taper point needle for these repairs.
o Use assistant to help maintain sterile field when more items are needed
o Spacing- stitches should be approximately, but no greater than 1 cm apart (avoids
creating dead spaces
o Never sew hymenal tags
o If in doubt, err on the side of too few stitches (as long as they are equally spaced)
Katlyn Carter
8.2 1st & 2nd Degree Repair
Typically, one or two interrupted stitches (two-bite technique may be necessary) in deep
will bring tissue together (to avoid dead space), followed by continuous, basting stitches down
the perineum to complete the closure.
Most often suture down the perineum with same strand used to repair the mucosa of the
vaginal floor
Katlyn Carter
8.2 1st & 2nd Degree Repair
With a continuous unlocked stitch in the vaginal floor, place your last stitch at the level
of the hymenal ring
o Move to the vertical plane of the tear and continue with a basting stitch
With a locked stitch complete the last locked stitch
o Insert your needle just outside the lock of the last stitch in the vaginal floor
o Bring the needle out where you want to begin closure of the perineum
Helps to control capillary bleeding and prevents the more shallow parts of the wound
from becoming disrupted during the healing process
Have your assistant hold the edges of the tear apart
o If you have no assistant, hold the edges of the tear apart with thumb and middle
finger of nondominant hand from below or above
o Begin closure by starting a row of basting stitches in the perineal body, beginning
about 0.5 cm below the introitus
o Entry and exit points for these stitches should be at least 8 to 10 mm from the skin
edge
o Depth of stitches can vary to close the depth of the tear at each level
o Remove the needle from tissue with thumb forceps
o Do NOT bring the needle through the skin surface; keep the suture inside the
external apex
Finishing up
o Trim the ears
o Remove the gauze tampon
Check to be sure no clots have collected behind the tampon while you
have been suturing
o Remove debris from the area
Be sure that everything (needle, gauze, suture fragments, etc.) is
accounted for and properly discarded
Sharps in the sharp container
Reference
Frye, A. (2010). Healing Passage. A midwife’s guide to the care and repair of the tissues