Rupture of the perineum - when surgical intervention is required?
November 25, 2010
Childbirth - a laborious process, it represents a considerable stress
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not only for the baby, but also for his mother. One of the problems that can occur during childbirth with a woman, this gap perineum. The reasons for this are many, but most of the perineal tears occur during childbirth abnormal or wrong and untimely assist women during childbirth. In nulliparous fractures occur about two times more often than in multiparous women.
What is the perineum
Perineum, or pelvic floor consists of muscle tissue, arranged in three layers, which carry domestic support pelvic organs (uterus, bladder
Urinary bladder - structure and function
and rectum). During labor, the muscles of the perineum are stretched, thus ensuring a passage nascent baby and after childbirth the muscles back to their original state.
In the course of the child's birth occurs compression and stretching of the muscles of the perineum, in violation of their circulation, and any deviation from the correct course of labor can lead to rupture:
- "Old" primipara (first woman with childbirth and older than 28 years);
- anatomical women (high crotch);
- developed muscles of the perineum (the women are actively involved in sports);
- swelling of the perineum (prolonged labor);
- rapid and swift childbirth;
- incorrect insertion of the head;
- inflammation of the external genital organs (vulvovaginitis);
- large fruit;
- scarring of the perineum (after delivery operations);
- improper maintenance of bearing-down period;
- incorrect position of mothers in the bearing-down period;
- improper behavior of women in childbirth;
- lack of extensibility perineal tissues (rigidity);
- narrow pelvis.
Depending on the origin, gaps can be spontaneous and violent. Also perineal tears are divided on the extent of which depends on the depth of the lesion:
- threatening to break - bulging crotch, becomes cyanotic, then a shiny fabrics, finishes first cracked and then by the rupture;
- first degree - damaged skin of the perineum (most posterior commissure), and vaginal mucosa;
- second degree - in addition to the skin and mucosa, in the process of damage involved muscles of the vagina;
- third degree - damaged the sphincter muscles of the vagina and rectum.
Perineal clinic and diagnostics
After birth, all women, without exception, are subject to inspection. On perineal tears indicate bleeding. The intensity of bleeding depends on the degree of rupture and its location (e.g., in the clitoris was well vascularized and the bleeding at that location can be significant even when cracks). To determine the integrity of the rectum, it introduced a finger. If there is no damage to the finger passes with difficulty, which prevents the sphincter.
The incision of the perineum, and the indications for it
The incision of the perineum or episiotomy, produce strictly according to indications, in particular, the threat of rupture of the perineum. Scientifically proven that cut wounds heal more quickly and accurately than the ripped and small long section prevents heavy and deep gaps:
- threatening rupture of the perineum;
- prematurity (to reduce pressure on the fetal head);
- shortening bearing-down period (myopia, high blood pressure
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, Heart defects);
- intrauterine fetal hypoxia;
- surgical intervention in childbirth (forceps);
- malposition (breech presentation).
Treatment of perineal
If you notice the gap sutured. Commonly used absorbable sutures (catgut), who are themselves "disappear" for 5-7 days. After the closure of the gap a woman can not sit down for two weeks, and stick to a special diet (broth, vegetable food, cereal). Daily sutures treated with a solution of potassium permanganate or hydrogen peroxide.
Perineal tear may be prevented, if you observe a few conditions:
- prepare women for childbirth (the correct behavior in attempts, proper breathing, mental attitude for delivery);
- proper management of labor (especially, taking possession of "the protection of the perineum");
- Use antispasmodics in childbirth (to improve blood circulation in the tissues);
- perineal massage during pregnancy;
- conducting special exercises for the muscles of the perineum.
Childbirth at home - take care of your security
November 12, 2009
One of the most difficult, responsibility, and at the same time one of the most exciting moments in every woman's life is birth. Today, one can argue the pros and cons of modern obstetrical practice, but definite opinion about the conditions in which, and how best to give birth, does not exist yet. The highest percentage of births are now performed in special maternity wards. However, a standardized approach to every woman in labor (ie without taking into account its anatomical features), too frequent (and sometimes totally unjustified) use rodostimuliruyuschih of drugs or Caesarean section, as well as the frank lack of simple human warmth from the medical staff do maternity is not the most ideal place for such a momentous event as the birth of a child.
That is why in recent years, some women prefer to give birth at home, surrounded by those whom they want to see next to a
. At the same time they receive the necessary psychological comfort for them
. However, in this case, one can hardly speak about the subject of high sterility as the instruments used and the environment
. Another option is the so-called family-run maternity hospital, the most approximate to the home, where during labor near the woman is dear and close person, and staff not only has all the necessary knowledge, but also takes into account, above all, the psychology and physiology of the pregnant woman , its needs and preferences, and the anatomical features of its constitutional body that allows you to select the most suitable position and the conditions for the flow of normal births
. In other words, it is "domesticated" hospital, a cross between a "normal" maternity home and a private apartment
. Unfortunately, such facilities are not yet widespread in the CIS countries, and the cost of their services for the average man in the street is quite high
. Therefore, in a family-type hospitals can give birth only sufficiently secured materially women
If you have no such possibility, but you are determined to give birth at home, you must take care of it in advance. First of all, you can not do without an assistant. It is desirable that this man was not only well "grounded" in the field of midwifery knowledge, but also have relevant practice was a positive attitude and is confident in the success of the upcoming case. By the way, it would be great if your decision to give birth at home is fully supported by her husband. After all, his negative attitude can be passed on to you, that at the time of delivery completely useless. And if something goes wrong (knock on wood!), It is the rest of your life will accuse you of this decision (even if not in words, but only in the mind).
However, other than an assistant and support of her husband, you are in the process of preparation for childbirth at home, too, would require some effort. One of the most important components of the preparation we have already mentioned - it is a positive mental attitude. No need to think about the upcoming birth and torment yourself with doubts about whether everything will be fine, and if anything happens to you or your child! If you are confident will result in a favorable, then everything will be fine! Create an image in your mind of the future child, and think that very soon you will see it. Well help acquire emotional stability of the reading of literature on training their own psyche, auditory training
Auditory training - you start to think positively?
Meditation - treats the body and the spirit
, Yoga and others. Besides mental exercise, we can not forget about his physical shape. After all, during labor reduced the abdominal muscles, pelvis, back, buttocks, perineum, not to mention the smooth muscle of the uterus, so the strength of these muscles is very important for normal births. Currently, there is a huge amount of exercise especially for pregnant women, the main thing in their implementation - do not overdo it. Do not engage until exhaustion, better to break the complex into several pieces and work it for two - three days. In the future, the strengthening of the muscles, you can easily overpower all the exercises in one session. Do not forget to walk every day, preferably in the nature.
Very useful before making a final decision on home birth talk to an experienced obstetrician, to hear his opinion, listen to advice. After all, families of the house - this is a serious step, which may decide not every woman and some of this method is absolutely contraindicated. For example, the presence of concomitant diseases of the cardiovascular system, anatomically narrow pelvis and in some other cases.