Perineum / suturing / episiotomy

Question 1

List the superficial pelvic floor muscles

Answer 1

bulbocavonosus (central)
transverse perinei (perpendicular)
ishchiocavernosus
external anal sphincter

Question 2

list levator ani muscles

Answer 2

pubococcygeus (centrally)
iliococcygeus (behind pubococcygeus)
ischiococcygeus (attached to ischial spines)
puborectalis

Question 3

Episiotomy definition

Answer 3

surgical incision into perineum
to enlarge outlet
to assist birth of baby

Question 4

describe mediolateral and midline episiotomy and compare outcomes

Answer 4

mediolateral
start midline of fourcette- runs backwards 3-4 cm, 60 degrees- stopping between tuberosities + anus
less likely to become 3/4d tear
more painful healing
bleeds more

midline
start midline of fourcette, cut straight down towards anus
more likely to become 3/4degree tear
less painful healing / bleeding

Question 5

what are reasons for episiotomy

Answer 5

presenting part is fully distending perineum + evidence of non-reassuring FHR pattern
- rigid perineum that is preventing birth (over extended time)
- evidence that perineum trauma is severe (e.g. button-holing)

Question 6

What are key points for episiotomy

Answer 6

• not routine
• verbal conesnt
• episiotomy cuts ACROSS muscles/ nerves vs spontaneous tear occurs BETWEEN muscles / nerves

Question 7

what is process to give episiotomy

Answer 7

wait until presenting part has descended enough to displace levator ani muscles (muscles are as thin as possible)- so incision is only going to affect skin / vaginal wall/ superficial muscles

infiltrate with lignocaine (unless epidural in situ)- wait 2-3mins

do a 4-5cm long incision

Question 8

what are rules of thumb to suture

Answer 8

there is bleeding that does not stop with reasonable amount of time with pressure
ragged tears / doesn’t approximate
tear is >1-2cm
there are pockets /bulges in tissue
woman wants it