Rupture of the perineum - when surgical intervention is required?
Childbirth - a laborious process, it represents a significant stress How to beat stress?Create an oasis not only for the baby, but also for his mother.One of the problems that can occur during childbirth with a woman, this gap perineum.The reasons for this are many, but most of perineal tears occur during childbirth abnormal or wrong and untimely assist women during childbirth.In nulliparous breaks occur about twice as often than in multiparous women.
What is the crotch
perineum, or pelvic floor consists of muscle tissue, arranged in three layers, which carry domestic support pelvic organs (uterus, bladder Urinary bladder - structure and function and rectum).During labor, the muscles of the perineum are stretched, thus ensuring a passage nascent baby and after childbirth the muscles back to their original state.
During childbirth occurs compression and stretching of the muscles of the perineum, impaired blood circulation in them, as any deviation from the correct course of labor can lead to rupture:
- «old» primipara (womanthe first births 28 years and older);
- anatomical women (high crotch);
- developed muscles of the perineum (the women are actively involved in sports);
- swelling of the perineum (prolonged labor);
- quick and fast delivery;
- incorrect insertion of the head;
- inflammation of the external genital organs (vulvovaginitis);
- large fruit;
- scarring of the perineum (after delivery operations);
- improper conduct of bearing-down period;
- wrong position in mothers bearing-down period;
- improper behavior of women in childbirth;
- insufficient stretch fabrics perineum (rigidity);
- narrow pelvis.
Depending on the origin, gaps can be spontaneous and violent.Also perineal tears are divided on the extent of which depends on the depth of the lesion:
- threatening rupture - bulging crotch, becomes cyanotic, then a glitter fabrics, finishes first cracked and then by the rupture;
- first degree - damaged skin of the perineum (most posterior commissure), and vaginal mucosa;
- second degree - in addition to the skin and mucosa, in the process damage the vaginal muscles are involved;
- third degree - damaged the sphincter muscles of the vagina and rectum.
perineal clinic and diagnostics
After birth, all women, without exception, are subject to inspection.On perineal tear indicates bleeding.The intensity of bleeding depends on the degree of rupture and its location (e.g., in the clitoris was well vascularized and bleeding at this point can be significant even when cracks).To determine the integrity of the rectum, it introduced a finger.If there is no damage to the finger passes with difficulty, which prevents the sphincter.
perineal incision and the indications for him
incision of the perineum or episiotomy, produce strictly according to indications, in particular, the threat of rupture of the perineum.Scientifically it is proven that cut wounds heal faster and neater than torn, and the length of the small incision to prevent severe and profound discontinuities:
- threatening rupture of the perineum;
- preterm labor (to reduce the pressure on the fetal head);
- shortening bearing-down period (myopia, hypertension How to deal with high blood pressure? , heart disease);
- intrauterine fetal hypoxia fetal hypoxia - the consequences of lack of oxygen in the body ;
- surgery in delivery (forceps);
- malposition (breech presentation).
When a gap sutured.Commonly used absorbable sutures (catgut), who are themselves "disappear" for 5-7 days.After the closure of the gap a woman can not sit down for two weeks, and stick to a special diet (broth, vegetable food, cereal).Daily sutures treated with a solution of potassium permanganate or hydrogen peroxide.
perineal tear may be prevented, if you observe a few conditions:
- prepare women for childbirth (the correct behavior in attempts, proper breathing, mental attitude for delivery);
- proper management of labor (especially, taking possession of "the protection of the perineum");
- use of antispasmodics in childbirth (to improve blood circulation in the tissues);
- perineal massage during pregnancy;
- conducting special exercises for the muscles of the perineum.