Operations that prepare birthmarks for childbirth

Expansion of the perineum and vagina

To expand the way out of the vagina and perineum, the operations of episiotomy and perineotomy are used.

Indications:

• complicated vaginal birth (pelvic presentation of the fetus, dystocia of the fetal shoulders, obstetric forceps, vacuum extraction of the fetus);
• distress of the fetus;
• cicatrical changes in the perineum, which are an obstacle to the birth of a child.

[1], [2], [3]

Perineotomy

After treatment of the skin of the perineum with 2% alcohol solution of iodine and local anesthesia during the eruption of the head at the height of the effort, a perineal incision is made with scissors with blunt ends. For this, one scissor brush is injected under the fingers control between the head and the perineal tissue. A 2-3 cm long incision is made on the median line of the perineum.

Episiotomy - lateral incision of the perineum. According to the above rules under pudendal anesthesia, a 2-3 cm long incision is made in the direction of the ischial tuber.

Expansion of the cervical canal

Expansion of the cervix by the application of dermal head forceps. Currently, the operation is performed only if there is a dead premature fetus (with late abortion). The conditions for performing the operation are the opening of the cervix at least 3-4 cm, the ruptured fetal bladder. Before the operation, make sure that there is no bladder. Under the control of 1-2 fingers of the left hand, inserted into the vagina and pressed to the anterior head, insert powerful two-tooth forceps or Muzo forceps and grasp the fold of the scalp skin. In this case, it should be clearly seen that the surrounding tissue did not get into the forceps. Easily pulling the forceps out, check to see if the head skin tissue is sufficiently entrapped. A gauze bandage with a weight of 300-400 g suspended by it is attached to the handle of the brushed forceps and transferred to it through the block. This operation speeds up the opening of the cervix, strengthens contractions.

Expansion of the cervical canal by constant pulling on the stem of the fetus. In modern midwifery, surgery is performed only if there is a dead premature fetus (extremely rare). The conditions for performing the operation are the opening of the cervix at least 3-4 cm, the ruptured fetal bladder. Before the operation, make sure that there is no bladder. When observing the rules of asepsis and antiseptic, the entire arm is inserted into the vagina, and only two fingers (index and middle) are inserted into the uterus. The inserted fingers grasp the front leg of the fetus and remove it from the vagina, a gauze loop is put on the foot, a weight of up to 200 g is hung to it and it is thrown over the block.

[4],

Artificial rupture of the bladder

Normally a fetal bladder bursts itself at the end of the first period of labor. In a number of cases, there is a need for an artificial rupture of the fetal bladder: a delay in the rupture of the fetal bladder, a flat fetal bladder, incomplete presentation of the placenta, delay in the birth of the second fetus in double, and before operative delivery through the natural birth canal in the presence of a whole fetal bladder. The technique of the operation is simple: if you follow the rules of aseptic and antiseptic in the vagina, enter the index or index and middle fingers and during the fray they break the shells of the strained bladder. If this method fails, then the bladder is torn off by the branche of the bullet forceps or by the forceps. Instrumental rupture of the bladder is performed under the control of the inserted fingers. Usually a bubble is ruptured in the center. In a large-water bubble, it is advisable to tear off the side so that the amniotic fluid flows more slowly. To this end, also before the head is pressed, do not remove the hand from the vagina and prevent rapid discharge of amniotic fluid (prevention of umbilical cord prolapse).

[5], [6], [7]