Perineal laceration

Introduction to perineal laceration The perineal laceration is divided into three degrees. Among them, I degree and II degree perineal laceration are superficial and have less bleeding. After correct suturing, most of them heal well. Perineal III degree laceration or complete perineal laceration, including vaginal laceration, perineal laceration and anal sphincter. The laceration, severe rupture can extend to the rectal wall, causing stool and gas incontinence. The cause of the accident is due to improper handling during the delivery process, and occasional trauma. Due to the vigorous implementation of the new method, the birth attendant properly protects the perineum and greatly reduces the incidence of perineal III degree laceration. Occasionally occurred in large hospitals in the city. basic knowledge The proportion of illness: 0.3% - 0.5% Susceptible people: more often in maternal Mode of infection: non-infectious Complications: postpartum urinary tract infections acne vulvar ulcers

Cause of perineal laceration

Fetal factors (23%):

Fetus with abnormal fetal development, expired children, hydrocephalus and other exposed areas with large diameter of the fetus, because the skull is hard, the fetal skull overlaps, deformation is difficult, it is necessary to pass the birth canal with a larger circumference, due to soft birth canal tissue Limited physiological extension leads to excessive swelling of the perineum during labor and causes perineal laceration. In addition, after the delivery of the huge fetal head, the significantly increased shoulders are prone to shoulder dystocia and increase the chance of laceration.

Midwifery factor (30%):

Improper biotechnology or unskilled protection of the perineum method is not correct. It does not follow the delivery machine to assist the fetal head to fully bend; the strength of the perineum is too small, or after the fetal head is delivered, the perineum is not continued to protect the perineum and cause laceration.

Maternal factors (20%):

Too old or too young, especially those who are over 35 years old, have poor perineal elasticity, small pelvic mobility, and the fetus can not fully expand during childbirth and easily cause laceration; It is less likely to cause lacerations.

Other factors (20%):

Delayed primipara (especially older primiparas) due to excessive mental stress, cerebral cortical dysfunction, excessive physical exertion, or due to head basin disproportionation, fetal position abnormalities caused by decreased fetal exposure, uterine contraction, resulting in prolonged labor or Stagnant. Because the fetus first exposed the soft birth canal for a long time, the birth canal is stagnant, edematous, necrotic, and the laceration is caused by the fragility of local tissue during childbirth. Urgent labor or fetal delivery too fast or oxytocin induces improper use of the product, making the contraction too frequent, too strong, the labor process is too short, the maternal force is too strong, all the perineum is too late to stretch, resulting in the first exposure of the fetus failed to normal delivery The machine was delivered, and the birth attendant failed to protect the perineum from laceration.

Perineal laceration prevention

In view of the pathogenic factors, prevention work can reduce the prevalence rate significantly. The prevention work is as follows:

1 Do a good job in family planning, multi-fetal and prolific inevitably cause relaxation and tearing of the pelvic floor muscles.

2 Immediately after the birth, the perineal tears are repaired to avoid wound infection and affect healing.

3 The first fetus will be tight, and the first dew will remain in the perineum for a long time. In order to avoid muscle tear or compression necrosis, a perineal incision should be performed.

4 puerperium sports therapy, usually start the second day after childbirth, so that the blood circulation of the small pelvis is improved, improve local muscle tension, strengthen overall health, and pay attention to avoid heavy physical labor or persistent cough.

Perineal laceration complications Complications Postpartum urinary tract infections acne vulvar ulcers

The most common complications are perineum, appendix skin inflammation and pressure ulcers (pressure sores). Due to the stimulation of feces, the perineal skin is often in a state of moisture and metabolite erosion, prone to skin redness, ulceration, and skin breakage. The ulceration can be deep and the muscle layer or ulceration extends to the labia, groin, etc.; contaminating the urethral orifice, the vaginal opening causes retrograde infection, which not only aggravates the patient's pain, but also brings difficulties to clinical nursing work.

Symptoms of perineal laceration Common symptoms Perineal traction pain, genital tear, vaginal laceration, fecal incontinence, vaginal entrance, mucosal tear, postpartum fecal incontinence

The third degree of perineal laceration occurs in the second stage of labor. When the fetal head is crowned, the midwife may notice a tearing of the perineum. Immediately after the delivery, a third degree laceration is found and sutured. Due to the degree of rupture, the symptoms are also Light and heavy, such as only a partial tear of the sphincter, only when the stool is thin, can not be controlled, False can not control, in this case, the patient tries to make his stool dry, control the stool mainly depends on the anal sphincter, does not cause the abdominal pressure to increase The stool suddenly overflows, but the self-regulated stool response depends not only on the sphincter, but also on the levator ani muscle. In severe cases, even if the stool is dry, it cannot be controlled. The vulva is often contaminated by the stool.

Examination of perineal laceration

During the examination, the perineum disappeared, the ends of the vagina and the rectum communicated, the skin behind the anus was radial wrinkles, and the sphincter was retracted at the anus to form small depressions. When the anus was found, the patient was inwardly contracted, and the sphincter regulation function could be tested. If the rectum is also torn, the rectal mucosa is red and turned outward.

Colposcopy, local biopsy at suspicious sites to improve the diagnosis of cervical disease.

Diagnostic diagnosis of perineal laceration

diagnosis

(1) Tearing the perineal III degree laceration during childbirth occurs in the second stage of labor. When the fetal head is crowned, the midwife may perceive the perineal part with a tearing sensation. Immediately after the delivery, the third degree laceration is found and the wound is wound. The healing is generally good.

(2) Old lacerations are inserted into the anus during the examination, and the patient is forced to inwardly by means of squatting the stool. At this time, the anal finger does not feel the contraction of the sphincter and is retracted due to the torn muscle. A small depression can be seen on the side of the anus, and a circular muscle end can be found at the tear.

Differential diagnosis

1Nervous disorders and injuries: Defecation is a reflex activity under the innervation of the visceral autonomic nerves and the brain. These nerves have dysfunction or injury, which can cause incontinence, such as stroke, shock, and shock, temporary bowel movements can occur. Incontinence; if the chest, waist, or sacral vertebrae damage the spinal cord or spinal nerves, it can cause paraplegia and cause fecal incontinence; in addition, after rectal mucosal resection near the anus, the rectal wall feels nerve defects, mental retardation, etc. can cause stool incontinence.

2 Muscle dysfunction and damage: the anal retraction and defecation function are maintained by the inner and outer sphincters and levator ani muscles. These muscles are loose, the tension is reduced, or they are cut, cut, or formed into large scars. Causes anal incontinence, if rectal prolapse, hemorrhoids, muscle relaxation caused by polyp release, reduced tension can also cause anal incontinence, the elderly or some diseases can also cause muscle atrophic anal incontinence, anorectal abscess, anal fistula, rectum Surgical cutting or resection of the sphincter can also cause anal incontinence, burns, burns, chemical corrosion can also cause anal incontinence of large areas of scars, and long-term diarrhea and anorectal cancer can also cause anal incontinence.

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