episiotomy suture

Perineal incision suture is the most commonly used surgery in obstetrics. The aim is to avoid severe perineal lacerations caused by natural childbirth and surgery, or to avoid obstruction of delivery due to overdose of the perineum. The method of incision has a side cut and a median cut. The clinical use of side cut is beneficial to the expansion of the vaginal surgery field and does not damage the rectum due to the extension of the cut product. The disadvantage is that the incision tissue has more bleeding, and the postoperative pain is heavier. Median cut may damage the anal sphincter or even the rectum and is rarely used. Treating diseases: huge fetus Indication 1. primipara, birth control, fetal head aspiration and breech delivery, all need to be perineal incision, according to the maternal discretion. 2. The perineal body is too long, too tight, the fetus is large, and the perineal is severely torn. 3. The second stage of labor extension or intrauterine asphyxia. 4. Prevention of fetal intracranial hemorrhage at preterm birth. Contraindications There are no special taboos. Preoperative preparation 1. Pay attention to appease the patient's psychology. 2. Regular disinfection within the range of the incision. 3. Local anesthetic. Surgical procedure Perineal side cut: the perineal side can be cut left and right, and the left side is appropriate. The incision point is selected between 4-5 points, the tangent line is 45 degrees with the vertical line, the scissors is perpendicular to the skin, and the maternal force is forced to suffocate. When the perineum is tight, the whole length of the incision is cut, and the length of the incision is generally 3-4 cm. Special conditions can be extended to 4-5cm. After cutting, use gauze to stop bleeding. If there is active bleeding, especially the small artery should be ligated or "8" suture to stop bleeding. Stitching: The perineum should be sutured as soon as possible after delivery of the placenta. Carefully do a good job of incision, whether there is a perineal laceration, the position of the incision, the opposite side, rinse again and disinfect the perineum, especially after washing around the anus, cover the anus with gauze and cotton balls, rinse the incision with metronidazole, no The gauze is inserted into the vagina to temporarily stop bleeding, and the incision is exposed. The vaginal mucosa is continuously sutured by chemically synthesized absorbable surgical suture (trade name DEXONII) 2/0 medical gut. The first needle should be sutured 1 cm above the tip of the incision. Hematoma, the line is not cut after ligation, leaving no dead space, continuous suture to the inside of the hymen ring knot. Continuously suture the muscle and subcutaneous tissue. Finally, 4/0 absorbable surgical sutures, continuous intradermal suture, the first needle and the last needle are knotted under the skin to bury the line under the skin. After the operation, the gauze that blocks the cervix is removed, and the conventional anus is used to check whether the gut passes through the rectal mucosa, and the re-sew is removed. In the suture process, adhere to the aseptic operation, each level should be carefully and correctly matched, moderately tighten the suture to stop bleeding, in order to facilitate the healing of the incision. complication (1) Loss of blood: Causes of bleeding from the perineal incision: 1 lateral or middle cut is easy to injure and perineal arteriovenous, bleeding is more than mid-cut; 2 perineal incision is earlier, fetal head fails to oppress perineal tissue bleeding More, the incision is large, the bleeding is not possible when the fetus is not delivered immediately; 3 complicated laceration caused by surgery; 4 pregnancy-induced hypertension syndrome; 5 coagulation mechanism disorders, such as disseminated intravascular coagulation, thrombocytopenic purpura. The delivery operator sometimes mistakes the wound bleeding for uterine contraction bleeding, which delays the treatment. Wound hemorrhage usually begins before the placenta is delivered, and it is a continuous active bleeding. It has nothing to do with uterine contractions, and it is not effective for uterine contractions. The uterine bleeding often flows out during contractions or by pressing the bottom of the sputum, often containing large blood clots. However, there are also wounds that bleed in the deep part of the vagina and are pushed out when the uterus is pressed. The recipient should pay attention to the bleeding of the wound after the perineal incision, and the active bleeding should be immediately sewed. The gauze should not be used to stop the bleeding; the placenta should be sutured quickly after delivery; the coagulation mechanism is treated according to the cause; The shock recipient supplemented the blood volume to correct the shock. (2) perineal hematoma: the causes of hematoma are: 1 the vascular end of the leaking retraction; 2 the bleeding point is not sutured in time, or the basic operation is not formal, the hemostasis is imperfect; 3 the needle pierces the blood vessels in the tissue, At that time, it was impossible to detect it; 4 deep blood vessels were contused and the blood did not flow out, which was not found during surgery. Therefore, in the prevention and treatment of hematoma, in addition to perfect operation, it is necessary to observe closely after surgery and find out early. The symptoms of postpartum perineal hematoma are mainly due to the pain of wounds gradually increasing, the anus swells, the local swelling and tenderness are gradually aggravated, and the anal can refer to cystic masses. The perineal hematoma is small. If you do not continue to increase, you should give it to the cold compress. Give the hemostatic drug. If you continue to enlarge, you should remove the wound suture to stop bleeding and re-sewn. (3) Incision infection: The main causes of infection are: 1 aseptic operation is not required, and the incision is contaminated; 2 the suture technique is poor, leaving a dead space, or the suture is too dense, the ligation is too tight, affecting blood supply and causing tissue Necrosis; 3 hematoma infection; prenatal vaginal infection, such as trichomonas vaginitis. The infection status often occurs after 3 to 5 days after the operation. The maternal wound continues to be painful, or it is aggravated after being relieved. It is often a painful, local redness. Press the incision with a finger to soften the area. If you open it, you can see the inflammatory exudate or The pus overflows, and the size and depth of the cavity are different. Although some women complained of wound pain, there was no obvious abnormality in the examination. The treatment with antibiotics and hot water bathing still did not relieve. It was often found that the incision was locally raised at different times after discharge from the hospital, and one or several thread heads were seen when the epidermis was opened. It can be cured after being cleared. Antibiotics and local hot compresses, bathing or physiotherapy should be given in the early stage of infection. Once a cavity or abscess is found, drainage should be completely expanded. If the vaginal cavity is vaginal, the sinus should be fully expanded. After partial cleaning, the second suture should be performed after the sprout is grown. Secondary Repair of Episiotomy can be performed under ramie, pudendal nerve block anesthesia or local anesthesia. First trim the edges of the wound and gently scrape the granulation surface to create a rough surface. The mucosa was sutured intermittently with a 1-0 gut, and the skin, subcutaneous and muscle were interrupted with a 7-gauge or nylon thread, and a thin tube was worn to protect the skin. 5 to 7d stitching.

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