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OPERATIVE OBSTETRICS Part 02

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LACERATIONS

  1. first degree : involves skin and vaginal mucosa but not underlying fascia and
    muscle
  2. second degree : involves fascia and muscles of the perineal body but not the
    anal sphincter
  3. third degree : involves the anal sphincter but does not extend through it
  4. fourth degree : extends through the anal sphincter into the rectal lumen

EPISIOTOMY
  1. 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)
  2. 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

  1. maternal : obstruction, active herpetic lesion on vulva, invasive cervical cancer, previous uterine surgery
  2. maternal-fetal : failure to progress, placental abruption or previa
  3. fetal : fetal distress, malpresentation, cord prolapse, certain congenital
    anomalies

Risks

  1. anesthesia
  2. hemorrhage
  3. infection (UTI, wound, endometritis)
  4. increased recovery time/hospital stay
OPERATIVE OBSTETRICS Part 02 OPERATIVE OBSTETRICS Part 02 Reviewed by Radiology Madeeasy on January 15, 2011 Rating: 5
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