Perineostomy

Perineostomy middle dissection of the perineum. Is made during childbirth, often in nulliparous, with the threat of a rupture of the perineum (the strong tension, thinning, whitening of the skin in the center of the perineum), infantile women with thin and narrow vulva (see), with the passage of the head of the fetus through the vulva large or extremely large head of the fetus. To perineostomy resort also when started asphyxia fruit to accelerate delivery, sometimes when imposing forceps. Perineostomy is done at the height of attempts at already proizvodaca head. Cut length 2-3 cm is under the control of the finger, blunt scissors. Cut only the skin. Perineostomy not always protects crotch from further divide. It is necessary to watch, that the head was progresyvus not very fast (keep your hand). After the birth of the effects on the mucous membrane of the vagina in the place of perineostomy impose kedgotoline joints, the skin of the perineum - silk. When the toilet postpartum women and adolescent girls the area of the seams are not washed, her gently dried with sterile tampon. Silk sutures are removed on the 5th day. The day after the removal of the stitches travaileth allowed to leave.

Perineostomy (perineotomia; from the Greek. perineos - crotch and tome - dissection) - dissection obstetric crotch of childbirth preventive
the purpose and some gynecological operations.
For fear that if the middle section of obstetric crotch may occur subsequent rupture of the sphincter, rectum, was offered episiotomy, i.e. Nadsiannia lips to a depth of 2 cm on one or both sides.
N. N. Phenomena believed that episiotomy very often does not protect against concurrent break crotch. He also highlighted the difficulty of predicting whether there is a gap perineum or not.
D. O. Ott and his followers indicated the feasibility of perineostomy, as incised wound crotch fused better than broken with traumatized, blood-soaked edges.
Currently, preventive dissection obstetric crotch used in medical practice, but not widely.
Method of perineostomy. The incision should not be done early (when presiunii head). Only after it is established that the head already cut through, at the height of attempts, the doctor proceeds to perineostomy, the midwife at this time holding the head.
Between the head of the fetus and the back wall of the vagina impose a spatula. On the middle line (raphe) crotch with a scalpel or straight scissors make the cut length of about 2,5-3 see Anesthesia is not required, since at the time the fight pain P. minimum and a woman in labor to cut does not respond.
Childbirth P. often used in nulliparous, primarily in cases when planned so-called Central of perineum (the whitening of the skin in the center of the perineum), with an overlay operation forceps, when gluteal the presentation of the fetus (in the latter case, anesthesia external genital organs), in elderly nulliparous, and also at beginning of asphyxia fruit for faster delivery.
Perineostomy is no guarantee that the cut will not be broken off on. So after P. must be accompanied by all obstetric art, to bring the head of a smaller size. Sometimes, especially when forceps delivery, when there is a danger of a complete rupture of the perineum with narusheniem sphincter, rectum, and also at the low crotch, it is advisable to make an incision in the side of the anus. Apply lateral P. in all cases of childbirth should not, because healing when it worse than the median, and the risk of bursting sphincter anal hole occurs not so often.
In gynecology perineostomy applied in individual cases if the operation fistulography. If vaginal-vesical fistula poorly available to the inspection, operation begin with side P. (section of Suharto). The incision is made in the direction of the buttock. To do this, the surgeon and one assistant impose fingers into the vagina and pulled aside the crotch. The incision is Crossed and legs m. levator ani. It is more convenient to make a cut on the left side, it allows considerably to stretch the vagina. In this context bleeding slightly more than the median P., so all the bleeding vessels should be covered; before you enter for further operations in the vagina of a mirror, you should close the wound with a cloth and fix it to the edges of multiple joints. In some cases it is necessary to do the bilateral incision in the perineum.
Recommended side perineostomy in extended vaginal removing the uterus to Sauto - Steckel in cervical cancer. At the end of the incision crotch sew usual method. Healing usually occurs by first intention.