Techniques of cutting, suturing the perineum and things to know

Episiotomy is one of the procedures performed when the mother is difficult to give birth or the fetus is too large, in order to help the baby be born more easily, avoiding possible complications such as perineal tear. not active. Indications for episiotomy such as:
The perineum is narrow, hard and thick. Edema due to prolonged labor or repeated visits; Mother has medical conditions such as heart failure, high blood pressure, pre-eclampsia; Large fetus or large head; Abnormal pregnancy position: face position, butt position; Premature pregnancy and risk of asphyxia. Therefore, the doctor will actively cut the episiotomy for the pregnant woman. Steps of episiotomy include:
1.1 Antiseptic and anesthetic Before episiotomy, the pregnant woman will be disinfected perineal vulva area. Then anesthetize the perineal area with Lidocan 2% 2ml and mix with 3ml distilled water. If the patient is given an epidural to relieve pain, there is no need for local anesthesia.

1.2 Determining the site of the cut An episiotomy is usually cut at a 45-degree angle at the 7 o'clock position. Locations without episiotomy such as:
Do not cut at 9 o'clock because this is an area of ​​easy bleeding such as Bartholin's gland, spongy tissues of the vulva. Midline: avoid central perineal, anal sphincter, and rectum. Normally, the right episiotomy of the woman is cut, only one side is cut and it is not necessary to cut both sides. Episiotomy cuts the vaginal sphincter, the superficial and deep transverse muscle, the vaginal wall, and the skin of the perineum. Do not cut deep to the levator anal muscle.

1.3 Performing episiotomy The woman is placed in the normal delivery position. The perineum is cut during uterine contractions when the perineum and vulva are distended or when forceps or suction are pulled. Using a sharp and straight scissors cut diagonally 45 degrees from the posterior edge of the vulva. The degree of cutting required can be from 2-4 cm, depending on the situation at the time.

After the baby has been taken out, the doctor will clean the perineal area, ensuring it is sterile before stitching. Make sure that the placenta is not left in the uterus and that the uterus has a good contraction, check the mother's condition, temperature, and blood pressure. Then start stitching each layer of the perineum.
Vaginal layer: suture with dissolvable thread, stitch from the inside to outside the two suture edges to avoid leaving a gap. Muscle layer: is the layer close to the skin, which needs to be sewn closed to avoid creating a hole between the skin layer and the muscle layer. Skin layer: sutured with nylon thread, suture similar to 2 layers of vagina and muscle layer. Then clean the sutures and the vulva area for the pregnant woman. Skin sutures will be removed after 3-5 days, depending on the condition of the wound.

After giving birth, the mother will feel pain at the episiotomy, and will be given pain relievers, along with antibiotics. Since the perineum is very close to the anus, this is where many bacteria reside. As a result, an episiotomy is very susceptible to infection. Therefore, perineal hygiene is important and necessary for postpartum women.

Some care measures include:
Keep the intimate area clean, wash with warm water 3 times a day, and especially after each use of the toilet; Wear loose, comfortable clothing and clean underwear; Gentle exercise or some physical therapy exercises to help blood circulation, wound healing; Abstain from sex until the wound is completely healed. An episiotomy is a procedure that is done to help the baby be delivered safely and to ensure that there are few complications for the mother. The technique of cutting and suturing has a significant influence on the mother's wound healing ability. After giving birth, pregnant women need to keep clean to prevent some possible complications. If you see some signs such as pain and bleeding from the tear, fever, or a bad smell in the vagina, etc., you should immediately notify your doctor for timely intervention.
In order for the whole process of pregnancy and birth to be convenient and safe, and for the baby and mother to be well taken care of after giving birth, you should register for maternity packages at reputable hospitals. At Vinmec International General Hospital, there is a package maternity service as a solution to help pregnant women feel secure because of the companionship of the medical team throughout the pregnancy. When choosing Maternity Package, pregnant women can:
The pregnancy process is monitored by a team of highly qualified doctors; Regular examination, early detection of abnormal problems; Maternity package to facilitate the birthing process; Newborns receive comprehensive care. Recommended video:
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