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Surgeries that prepare the birth canal for delivery
Last reviewed: 06.07.2025
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Expansion of the perineum and vagina
To widen the opening of the vagina and perineum, episiotomy and perineotomy operations are used.
Indications:
- complicated vaginal births (breech presentation, fetal shoulder dystocia, obstetric forceps, vacuum extraction of the fetus);
- fetal distress;
- cicatricial changes in the perineum that are an obstacle to childbirth.
Perineotomy
After treating the perineal skin with a 2% alcohol solution of iodine and local anesthesia, during the cutting of the head at the height of pushing, an incision is made in the perineum with blunt-ended scissors. To do this, one branch of the scissors is inserted under finger control between the head and the perineal tissue. A 2-3 cm long incision is made along the midline of the perineum.
Episiotomy is a 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 tuberosity.
Dilation of the cervical canal
Dilation of the cervix using skin-head forceps. Currently, the operation is performed only in the presence of a dead premature fetus (in late abortion). The conditions for performing the operation are the opening of the cervix by at least 3-4 cm, a ruptured fetal bladder. Before the operation, it is necessary to make sure that there is no fetal bladder. Under the control of 1-2 fingers of the left hand, inserted into the vagina and pressed to the presenting head, powerful two-pronged forceps or Musot forceps are inserted and the fold of skin of the head is grasped with them. In this case, it is necessary to clearly make sure that the surrounding tissues are not caught in the forceps. By gently pulling the forceps outward, they check whether the tissue of the skin of the head is grasped powerfully enough. A gauze bandage with a weight of 300-400 g suspended from it is tied to the handle of the jaws of the forceps and thrown over the block. This operation accelerates the opening of the cervix and intensifies contractions.
Dilation of the cervical canal by constant traction on the fetal leg. In modern obstetrics, the operation is performed only in the presence of a dead premature fetus (extremely rare). The conditions for performing the operation are the opening of the cervix by at least 3-4 cm, a ruptured fetal bladder. Before the operation, make sure that there is no fetal bladder. If the rules of asepsis and antisepsis are observed, the entire hand 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 thrown over the foot, a weight of up to 200 g is suspended from it and thrown over the block.
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Artificial rupture of the amniotic sac
Normally, the fetal bladder ruptures on its own at the end of the first stage of labor. In some cases, there is a need for artificial rupture of the fetal bladder: delayed rupture of the fetal bladder, flat fetal bladder, incomplete placenta previa, delayed birth of the second fetus in twins, and before operative delivery through the natural birth canal in the presence of an intact fetal bladder. The technique of the operation is simple: observing the rules of asepsis and antisepsis, the index or index and middle fingers are inserted into the vagina and during contractions, they tear the membranes of the tense fetal bladder. If this technique fails, the bladder is ruptured with the branches of bullet forceps or forceps. Instrumental rupture of the fetal bladder is performed under the control of the inserted fingers. Usually the bladder is ruptured in the center. In case of polyhydramnios, it is advisable to rupture the bladder from the side so that the amniotic fluid flows out more slowly. For this purpose, you should also not remove your hand from the vagina until the head is pressed down and prevent the rapid discharge of amniotic fluid (prevention of umbilical cord prolapse).