Anatomy of the Perineum 5

Question 1

What is an episiotomy?

Answer 1

• Enlargement of the distal birth canal to facilitate a difficult birth
  
  • median
    
    • cut the skin, vaginal wall and perinal body
  • medio-lateral
    
    • skin
    • vaginal wall
    • bulbospongiosus
    • superficial transverse perinei
    • UG diaphragm

Question 2

What is uterine prolapse and what are the muscular causes?

Answer 2

• Herniation of the uterus through the pelvic diaphragm into the vagina
• Medial pubococcygeus muscle is the thickest, strongest muscle of the pelvic diaphragm
  
  • most important for visceral support
• Damage streatching can lead to prolapse (such as from repeated childbirth)

Question 3

What is the clinical significance of the retrouterine pouch and how is it accessed?

Answer 3

• Blood, infection, etc. will leave fluids in this pouch
• Accessed through the posterior fornix, which is adjacent
  
  • used in sampling of the peritoneal fluid

Question 4

What would be the effect of a lumbar subarachnoid or epidural block for a female?

Answer 4

• Would anesthetize all of the uterus and entire birth canal
• Will also hit the lower extremities

Question 5

What would be the effect of a sacral epidural nerve block?

Answer 5

• Would anesthetize sensory fibers from the parasympathetic pelvic splanchnic nerves
• Cervix and entire birth canal will be anesthetized
• Uterine contractions can still be felt
• Legs are mostly unaffected
• Nerve block of choice

Question 6

What would be the effect of a pudendal nerve block?

Answer 6

• A block at the ischial spine will anesthetize the outflow portion of the birth canal
• Will not anesthetize the cervix and upper vagina