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Perineal ruptures during childbirth
Last reviewed: 23.04.2024
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[Risk factors for perineal rupture
Crotch ruptures are more often observed with developed musculature, small tissue compliance in age-related primipara, narrow vagina with inflammatory changes in tissues, edema of tissues, cicatricial changes after previous births. Of great importance are the shape and size of the bony pelvis of the mother, the size of the fetal head and the density of its bones, as well as the size of the shoulders. The overgrowth of the vulvar ring occurs in the incorrect biomechanism of births, when the head is erupted not by the smallest oblique size, but by the straight, large oblique, etc.
In the case of surgical delivery, the perineal and vaginal wall ruptures most often result from the imposition of obstetric forceps.
In terms of the degree of tissue rupture, a gap in the perineal I-III (complete and incomplete) is distinguished.
- When the crotch of the 1st degree ruptures, the posterior spike, the posterior wall of the vagina within the umbellate fossa and the skin of the perineum are ruptured. As a rule, this gap is not accompanied by bleeding.
- When the crotch of the second degree ruptures, apart from the posterior adhesion, the posterior wall of the vagina and the perineal skin, the fascia and muscles of the tendon crotch center are additionally torn (in this center the muscles and fasciae of all sin of the floors of the gas bottom converge). This gap is accompanied by bleeding.
- The rupture of the perineum, especially of the third degree, should be diagnosed and withered immediately after birth. To this end, a finger is inserted into the rectum and, checking the intestinal wall, check the integrity of the intestine and sphincter.
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Treatment of perineal rupture
When the crotch of the third degree ruptures, apart from the skin and muscles of the perineum, the sphincter ruptures (incomplete rupture of grade III), and sometimes also the mucous membrane of the rectum (complete rupture of the third degree); Before suturing the ruptures, it is necessary to excise the crushed and necrotic tissues.
In the process of sewing a gap of grade III, it is very important to clearly orientate in its topography, for which it is necessary to expose the edges of the wound with Kocher's clamps so that the injured tissues lie after as much as before the rupture.
Particular attention is required to sew a complete rupture of the third degree of the perineum. First, the upper corner of the rectal rupture is sutured, knotted catgut sutures connect the edges of the intestinal wall (without puncturing the intestinal mucosa). After restoring intestines, you need to find and sew up torn sections of the sphincter, connecting both ends of the sphincter along the middle line.
When sewing the central rupture of the perineum, the remaining tissues of the posterior adhesion are scissorized with scissors, and then the wound is sutured layer by layer.
The hygienic toilet of the external genitalia is carried out 2-3 times a day with a solution of potassium permanganate, dried and treated with 1% iodopyrone solution or 1% alcoholic solution of brilliant green, etc. Skin stitches are removed from the perineum on the 5th-6th day.
When the crotch of the third degree is ruptured, a diet that does not form feces is recommended. On the eve of the removal of the sutures, the laxative is prescribed for the puerperium - magnesium sulfate, vaseline oil, etc.
If suppuration of the joints, they should be removed, and the wound surface should be cleaned daily of purulent and necrotic masses of hydrogen peroxide, rivalenol solution and furacilin. UFO is also recommended. On the wound, apply a gauze bandage with hypertonic sodium chloride solution (until the amount of purulent discharge is reduced), and then with 1% iodopyrone solution for 4-5 hours. After this, make an ointment pad (0.25% methyl uracil ointment, solcoseryl ointment or jelly, Iruksol, vulnozan, etc.). After cleansing the wound, the perineum is sewn again.