LACERATIONS first degree : involves skin and vaginal mucosa but not underlying fascia and muscle second degree : involves fascia and...
LACERATIONS
- first degree : involves skin and vaginal mucosa but not underlying fascia and
muscle - second degree : involves fascia and muscles of the perineal body but not the
anal sphincter - third degree : involves the anal sphincter but does not extend through it
- fourth degree : extends through the anal sphincter into the rectal lumen
EPISIOTOMY
- Definition : making an incision in the perineum at the time of delivery midline (better healing, increased risk of deep tear) vs. mediolateral (less risk of extensive tear, poorer healing/more pain)
- Indications:
- to prevent a tear (episiotomy easier to repair)
- to relieve obstruction of the unyielding perineum
- instrumental delivery
- controversy over whether it is preferable to make a cut, or let the perineum tear as needed
CESAREAN DELIVERY
Indications
- maternal : obstruction, active herpetic lesion on vulva, invasive cervical cancer, previous uterine surgery
- maternal-fetal : failure to progress, placental abruption or previa
- fetal : fetal distress, malpresentation, cord prolapse, certain congenital
anomalies
Risks
- anesthesia
- hemorrhage
- infection (UTI, wound, endometritis)
- increased recovery time/hospital stay
