cicatrización perineal anómala
Anatomy of perineal injuries: correct repair
Dr. Margarita Manresa RNM PhD margamanresa@gmail.com
Anatomy of perineal injuries
Perineal injuries: social impact
...the courts say... 5. Perineal injuries: 4th most common obstetric claim in UK: €36 million (2000–2010)
....women say... 3. Lack of information about perineal injuries during pregnancy 4. Limited postpartum follow-up 5. Feeling of abandonment
... the literature says... 1. It is the most frequent obstetric complication (80%) 2. Pain and its impact on the establishment of breastfeeding make adaptation to motherhood more difficult
Content
Obstetric perineal injuries
Perineal repair
Incorrect suturing of second-degree perineal tears
What are they?
Technique and materials
Identify the structures involved in the injury
Incorrect suturing of first-degree perineal tears
To conclude
Anatomy of perineal injuries
Obstetric perineal injuries
- Perineal cleansing, glove change, and perineal asepsis
- Identify injured perineal structures
- Establish a suturing strategy
pre-repair assessment
first-degree perineal injury
- Vaginal mucosa
- Vestibular mucosa
- Perineal skin
- Labia minora
second-degree perineal injury
- Bulbocavernosus muscle
- Superficial transverse perineal muscle
otras lesiones
- Vaginorectal fascia
- Levator ani muscle
- Buttonhole tear
lesiones del esfínter anal
- External anal sphincter (3A / 3B)
- Internal anal sphincter (3C)
- Rectal mucosa (fourth-degree tear)
Anatomy of perineal injuries
SUPERFICIAL pelvic floor muscles: PERINEAL MUSCLES
Isquiocavernosus muscle Bulbocavernosus muscle Superficial transverse perineal muscle (External anal sphincter muscle)
PERINEAL BODY
Assessment of the perineal muscles
Anatomy of perineal injuries
Anal sphincter complex
(Puborectalis muscle)External anal sphincter:
- subcutaneous part
- superficial part
Internal anal sphincter muscle
Assessment of the anal sphincter complex
cicatrización anómala
reparación LESIÓN PERINEAL: correcta TÉCNICA Y MATERIAL DE SUTURA
2. Presenta tu genially…
A través de un esquema, para contar todo de forma ordenada.
4. Presenta tu genially…
Tras practicar mucho. ¡La mejor improvisación es la que se trabaja!
FIRST-DEGREE PERINEAL INJURY
PrimiparityNVD (No Epidural) BW: 3010g
Primiparity NVD BW: 2680g
PrimiparityNVD BW::4050g
PrimiparityNVD BW: 3480g
Primiparity NVD. 1DPI. BW: 3280g
SECOND-DEGREE PERINEAL INJURY
PrimiparityNVD . 2DPI. BW: 3750g
Primiparity Forceps. Episiotomy. BW: 3360g
PrimiparityNVD. Episiotomy + 2DPI .BW: 3370g
When a perineal tear is present:
2. Establish a suturing strategy: where do I start? — bleeding — tension…
1. Correctly identify the injured structures in a perineal wound
3. Clean the area. Change your gloves. Prepare the area using aseptic technique and drape
5. Postpartum follow-up: analgesia + perineal wound examination
4. Use the correct suture (material and thickness). Perform the appropriate technique
cicatrización perineal anómala
Anatomy of perineal injuries: correct repair
Dr. Margarita Manresa RNM PhD margamanresa@gmail.com
Assessment of the anal sphincter complex
1º Ensure adequate analgesia2º Assess the direction of the muscle fibers3º Insert the index finger into the anus and perform a pill-rolling maneuver 4º Keep the index finger in the anus and move it anteriorly to expose the injury 5º Gently grasp and apply traction to the injured fibers and observe their direction:
- External anal sphincter: reddish, fibers arranged transversely, directed posteriorly
- Internal anal sphincter: pale, fibers arranged longitudinally, retractile
- Rectal mucosa: thin tissue, almost transparent
Assessment of the perineal muscles
1º Ensure adequate analgesia2º Assess the direction of the muscle fibers3ºInsert the index finger into the anus and move it anteriorly to expose the injury 4º Gently grasp and apply traction to the injured fibers and observe their direction
- Bulbocavernosus muscle (1): directed anteriorly
- Superficial transverse perineal muscle (2): directed toward the ischial tuberosity
- External anal sphincter (3): directed posteriorly
Anatomy of perineal injuries: correct repair
Marga Manresa
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Transcript
cicatrización perineal anómala
Anatomy of perineal injuries: correct repair
Dr. Margarita Manresa RNM PhD margamanresa@gmail.com
Anatomy of perineal injuries
Perineal injuries: social impact
...the courts say... 5. Perineal injuries: 4th most common obstetric claim in UK: €36 million (2000–2010)
....women say... 3. Lack of information about perineal injuries during pregnancy 4. Limited postpartum follow-up 5. Feeling of abandonment
... the literature says... 1. It is the most frequent obstetric complication (80%) 2. Pain and its impact on the establishment of breastfeeding make adaptation to motherhood more difficult
Content
Obstetric perineal injuries
Perineal repair
Incorrect suturing of second-degree perineal tears
What are they?
Technique and materials
Identify the structures involved in the injury
Incorrect suturing of first-degree perineal tears
To conclude
Anatomy of perineal injuries
Obstetric perineal injuries
pre-repair assessment
first-degree perineal injury
second-degree perineal injury
otras lesiones
lesiones del esfínter anal
Anatomy of perineal injuries
SUPERFICIAL pelvic floor muscles: PERINEAL MUSCLES
Isquiocavernosus muscle Bulbocavernosus muscle Superficial transverse perineal muscle (External anal sphincter muscle)
PERINEAL BODY
Assessment of the perineal muscles
Anatomy of perineal injuries
Anal sphincter complex
(Puborectalis muscle)External anal sphincter:
- deep part
Internal anal sphincter muscleAssessment of the anal sphincter complex
cicatrización anómala
reparación LESIÓN PERINEAL: correcta TÉCNICA Y MATERIAL DE SUTURA
2. Presenta tu genially…
A través de un esquema, para contar todo de forma ordenada.
4. Presenta tu genially…
Tras practicar mucho. ¡La mejor improvisación es la que se trabaja!
FIRST-DEGREE PERINEAL INJURY
PrimiparityNVD (No Epidural) BW: 3010g
Primiparity NVD BW: 2680g
PrimiparityNVD BW::4050g
PrimiparityNVD BW: 3480g
Primiparity NVD. 1DPI. BW: 3280g
SECOND-DEGREE PERINEAL INJURY
PrimiparityNVD . 2DPI. BW: 3750g
Primiparity Forceps. Episiotomy. BW: 3360g
PrimiparityNVD. Episiotomy + 2DPI .BW: 3370g
When a perineal tear is present:
2. Establish a suturing strategy: where do I start? — bleeding — tension…
1. Correctly identify the injured structures in a perineal wound
3. Clean the area. Change your gloves. Prepare the area using aseptic technique and drape
5. Postpartum follow-up: analgesia + perineal wound examination
4. Use the correct suture (material and thickness). Perform the appropriate technique
cicatrización perineal anómala
Anatomy of perineal injuries: correct repair
Dr. Margarita Manresa RNM PhD margamanresa@gmail.com
Assessment of the anal sphincter complex
1º Ensure adequate analgesia2º Assess the direction of the muscle fibers3º Insert the index finger into the anus and perform a pill-rolling maneuver 4º Keep the index finger in the anus and move it anteriorly to expose the injury 5º Gently grasp and apply traction to the injured fibers and observe their direction:
Assessment of the perineal muscles
1º Ensure adequate analgesia2º Assess the direction of the muscle fibers3ºInsert the index finger into the anus and move it anteriorly to expose the injury 4º Gently grasp and apply traction to the injured fibers and observe their direction