Rales are relating to frequently encountered injuries arising during the delivery. They occur at the stage of expulsion of the fetus from the uterus. The rupture of the perineum refers to the most frequent damage to this type. It is mainly associated with the insufficient elasticity of body tissues.

Causes of traumatization of crotch tissues in childbirth

The crotch is a totality of the muscles of the pelvic bottom between the anal hole and the rear wall of the vagina. It consists of anterior (urogenital) and rear-inadlines. During childbirth, when the fetal passage is passed on the generic channel, soft crotch tissues are stretched. If elasticity is insufficient, the gap is inevitable. The frequency of pathology is approximately 1/3 from the total number of labor.

The predisposing factors include:

• the first births aged after 35 years, when there is a natural reduction in muscle elasticity;
• incorrect behavior of the manufacturers - especially characteristic of inexperienced primary women who are inclined to be a panic and do not fulfill the teams of the doctor and obstetrician;
• non-timely or incorrect medical care;
• the use of obstetric forceps or vacuum extraction;
• fast delivery - pressure on soft tissues is significantly enhanced;
• inflammatory processes in the genitals leading to thinning and reduced muscle elasticity;
• scars remaining after previous injuries or surgical manipulations;
• weakness of generic activity, long-lasting swells, causing edema.

The threat of a crotch break increases with or the birth of a large fetus (more than 4 kg), during childbirth, later than 42 weeks of gestation (transferred child).

The classification of generic crotch injuries allows you to highlight the following severity of breaks:

• 1 degree - there is damage to the external layer of the vagina or the impaired integrity of the skin;
• 2 degrees - the injuries of the muscular layer of the organ;
• 3 degrees - traumatization is susceptible to the outer sphincter until a complete break;
• 4 degrees - occurs in rare cases, the trauma of the walls of the rectum is characteristic.

With damage to the back wall of the vagina, the muscular layer of the pelvic bottom and the skin of the surface with the preservation of integrity rear Passage Diagnose the central rupture of the perineum. In this case, the appearance of a child to light occurs through an artificially created channel. This heavy trauma occurs extremely rarely.

Treatment of injuries should be immediate because they are fraught with severe consequences. The most dangerous among them is strong bleeding. Through the open wound into the body, the pathoral microorganisms can easily penetrate the inflammatory process in the genitals.

The disorders of the vagina microflora can be attributed to the more distant negative consequences of the generic injury. Rales 3 and 4 degrees can lead to urinary incontinence and feces, other violations in the operation of the urethra and rectum.

Diagnosis of damage does not cause difficulties. Immediately after the end of the birth (release of the pilot), the doctor is inspected by the state of generic paths, which allows you to determine the presence of gaps and the degree of their severity.

Treatment

After the detection of injuries using special vaginal mirrors, their embarrassment is made. It is very important to determine the severity of damage. The rupture of the perineum first and second degree requires the imposition of seams, which is produced under local anesthesia. The pericacy of the perineum is restored by the ketgut seams that are solved with themselves alone, or the silk that need to be removed. At the first degree of seams are imposed in one layer, with the second - two.

Treatment of 3 degree breaks implies the use of general anesthesia. The manufacturers produce inspection of not only the muscular layer, but also the rear pass and the rectum. In this case, the embedding begins with the restoration of the integrity of the walls of the rectum and the sphincter. Then make the stacking of seams to eliminate damage to the skin. Sewing is carried out immediately or for half an hour after delivery.

If the risks of breaks arise during childbirth, at the birth of a large child and in the case of rapid genera - shows episotomy (cut cut). Thanks to this intervention, the exit from the vagina becomes wider, which prevents damage to the rectum and blood vessels.

Conduct helps not only avoid getting injured by the guide, but also stops bleeding and minimizes the negative consequences for the child.

Before carrying out the section, the genitals are treated with iodine solution. The dissection is made using special scissors at the moment when the sweat becomes the most intense. This moment is more favorable for manipulation, because with strong voltage the woman feels less pain. The dissection length is 20 mm.

Care of seams after embarking breaks

How much does the crotter break after childbirth and how to care for the seams?

The healing of self-sessing seams requires two weeks. Typically, the process is favorable. Sews from other materials will be delayed within a month. The recovery duration depends on the individual characteristics of the organism and the severity of the gaps. The patient should know the rules for the care and comply with medical recommendations that will help her recover in the shortest possible time.

Rules of behavior after delivery:

1. Regularly process seams with a greenan or a solution of potassium mangartage (no less often 2 times a day). Immediately after childbirth, it makes the midwife, in the future the processing is performed independently.
2. Observe the rules of personal hygiene: as often as possible wash the genital organs with warm water, change the gaskets every 2-3 hours;
3. Turning only cotton underwear. It should be free and no excess pressure on the crotch.
4. Taking a shower, direct the water stream from top to bottom. It is impossible to rub the genital organs with a washcloth or a rigid towel. It is necessary to dry the skin with soft flushing movements.
5. Being at home, it is recommended to dry the affected place with the help of air baths, ointments (Solfossuril, Bapten), make special gymnastic exercises.
6. Do not lift weights above 3 kg, avoid physical Loads and sports.
7. To introduce products to the diet that provide normal defecation and exclude constipation.
8. The sex life of spouses can be renewed no earlier than 1.5-2 months after complete healing of damage.

Separately, the need to regularly visit the toilet should be highlighted. The process of urination and defecation delivers strong painful sensations. Fear before pain and discomfort causes a woman to postpone the process until the latter. The accumulation of carrot masses has an even greater load on the muscles of the perineum, which only aggravates the severity of the situation.

To remove pain, painkillers and glycerol candles can be assigned to softening the path masses. With pronounced swelling, an ice bubble is applied. With the ruptures of the third degree, antibacterial drugs are prescribed to eliminate the infection of the rectum.

During the first 10-14 days after breaking breaks, it is forbidden to sit. Mom should relax more more, do not make sharp movements. Each food should be standing or lying with a bedside table. Kinder baby needs lying.

How much can you sit?

You can sit on solid surfaces two weeks later, on a soft one three weeks. When returning from the maternity hospital in the car, the patient is recommended to occupy the position of the middle trip to eliminate the pressure on the crotch.

Complications

Among the frequent complications are distinguished:

• painful sensations;
• the discrepancy of the seams;
• strong itching and swelling;
• suppuration;
• bloody issues.

To remove pain and itching, a quartz or infrared lamp is prescribed, the lubrication of the seams by ointment of Kontraktubex. It often testifies to the healing process, but if it is too bothering, it is recommended to wash the genital organs with cool water.

Mine isolation usually indicate infection. In this case, antibiotics are prescribed, Mazi Levomekol, Vishnevsky, Solfirel. Chlorhexidine and hydrogen peroxide are used for disinfection of the wound cavity. The presence of bleeding requires additional embeding of the damaged area.

The most dangerous complication occurs if the seams were separated. In this situation, it is strictly forbidden to engage in self-medication. Woman should immediately call ambulance. Usually re-imposing seams in a medical facility.

Preventing breaks

There is a commodity opinion that inevitable. This is not true. Prevent damage to the crotch can be thoroughly preventive preparation even during pregnancy. Preventive measures include the performance of special intimate gymnastics, crotch massage.

Massage

Best Prevention is a regular massage. It can be done on any time, but still better period It is the third trimester. The benefits of massage is as follows:

• activates blood circulation, improves metabolism in tissues;
• trains muscle crotch cloth;
• gives muscles the necessary softness, fuel and elasticity;
• promotes relaxation, which significantly reduces the risks of damage.

For maximum efficiency, the crotch massage for the prevention of ruptures is made using natural oil. You can use linen, pumpkin, rapid, olive oils. There is also special oil for a crotch massage that can be purchased at the pharmacy.

Before the massage you need to take a warm shower. Intestine I. bladder Must be emptied, hands should be carefully flushed. Crotch, genitals and fingers lubricate with oil. A woman needs to take a comfortable pose and relax as much as possible. The fingers entered into the vagina make soft movements towards the anal hole, pressing the rear wall of the vagina. Nazhima should be alternating with conventional massage movements.

The duration of massage is 5-7 minutes. Usually, a woman is difficult to carry out the procedure independently, since it prevents her belly, so the help of people close to her is very desirable. A number of contraindications should be taken into account, in which massage cannot be carried out. In particular, these are inflammatory and infectious diseases genital organs. Massage in this case can be carried out only after complete cure, otherwise it will contribute to the further spread of infection in the body.

The massage is categorically not recommended in the threat of pregnancy interrupt or, improper preservation of the fetus and in the presence of pregnant skin diseases. It is very important that the procedure does not cause any negative emotions or physical discomfort. Before it is fulfilled, you need to obtain the consent of the doctor who has a future mother.

Gymnastics

Effective prophylaxis includes the performance of special gymnastic exercises that contribute to improving the elasticity of the perineum.

Exercise 1. Being sideways to the back of the chair and pretended to her with your hands. Distribute alternately to the side of the foot 6-10 times.

Exercise 2. Widely put legs. Slowly sit down, holding the body in this position for a few seconds, then also slowly climb. Make an exercise 5-6 times.

Exercise 3. Feet put on the width of the shoulders. Deeply breathe, alternately pull the stomach, and then relax his muscles. The back at the same time should be straight.

Exercise 4. Alternately strain and relax the muscles of the anal hole and vagina. The exercise can be done both in the position lying and sitting. This exercise You can do not only at home, but also at work and even in public transport.

Food

Pregnant woman should pay attention to its diet. It is necessary to include vitamin E. It can be taken as in capsules and drink it. vegetable oilwhich is rich in these vitamin. The menu should include a fish that is rich in greasy acids or fish fat. From 28-30 weeks recommended to take a dessert spoon apple vinegar Before breakfast.

The elimination of meat in the third trimester also contributes to the prevention of breaks. If a woman is not ready for such a solution, you should at least check the smoked products in the menu.

Other preventive measures include:

• regular visits to the gynecologist, fulfilling all its recommendations;
• timely registration for pregnancy (no later than 12 weeks);
• visit courses of prenatal training for learning proper behavior during childbirth;
• timely identification of inflammatory processes in the genital organs and their complete cure is still at the stage of pregnancy;
• implementation of all the instructions of the doctor and obstetrician during childbirth.

Birth is a long-awaited process. Often, in the late pregnancy, women are looking forward to the beginning of the battles, especially if these are the first birth, and are asked by the most different issues: how the childbirth will pass, what can prevent normal to give birth, does the child suffer, will the child suffer, what is epiizotomy and perineotomy? We will cover the last of the listed questions today.

Epsotomy (median-lateral episotomy) is a surgical dissection of soft crotch and vaginal tissues.

Perineotomy is also a surgical dissection of crotch and vaginal tissue, but made according to the middle line in the direction of the vagina to the anus.

At present, episodemia is used very widely, and perineotomy is much less likely. The fact is that the holding of episiotomy is much less likely to complicate in the form of damage to neighboring bodies. Sometimes it happens that the incision must be extended (large fetal head, incorrect head insert, extensitive positions of the fetus head). In this case, the episotional incision simply continues, and the risk of bleeding is not increasing and the risk of damage to other structures is not created, since all manipulations occur within the skin, subcutaneous fatty tissue and muscles.

When performing perineotomy, the incision is obtained limited in length, and it is difficult to extend it. It depends on the anatomical features (high crotch or low). But in any case, with perineotomy, there is a risk of spontaneous extension of the cut, that is, in the sweeps of the crotch tissue, the cut is tensioned and the incision is extended to the gap, while there is a risk that the gap will last to the anus and there will be damage to the sphincter or rectum.

The high crotch is an anatomical structure of the crotch, when the distance between the input into the vagina and anus exceeds 7 cm. Low crotch is the distance between the anus and the input in the vagina is less than 2 cm.

Why is the cutting of the crotch in childbirth?

Epsotomy and perineotomy are performed in order to expand the exit from the generic paths (vulvar ring). If the testimony for epision and perineotomy is subject to testimony, its implementation is able to prevent negative consequences for the mother and child.

Indications for incisive

From the mother

The threat of the crotch break in childbirth. The cringe breaks can also occur on healthy originally tissues, and by the old rubles (episiotomy in previous birth). More susceptible to such a complication of a woman with originally dry and sensitive skin, systemic diseases of the connective tissue (sclerodermia, dermatomyositis and others), diabetes and some skin diseases (for example, ichthyosis). Epsotomy is performed in a wailing period when the threat of crotch breakage occurs. The threat of crotch break is diagnosed visually, the fabric is tensioning until transparency, the skin is thin, glitters.

When conducting obstetric operations in childbirth. The overlapping of weekends of obstetric forceps and vacuum - extractor, as a rule, requires episiotomy to facilitate the extraction of the child and eliminate the rupture of the perineum.

To facilitate the seamless period in a pregnant woman with extragnenital pathology. This includes cardiac pathology, hypertensive disorders and other pathologies. Epsotomy reduces the waiting period, which reduces the load for the mother.

Bleeding in childbirth exceeding physiological norms. In this case, it is also necessary to speed up the birth of a child and find a source of bleeding. During bleeding, both the mother suffers and the fetus while he is connected with the mother-in-law.

The development of preeclampsia in childbirth or the deterioration in the course of preeclampsia in the waiting period. Lifting arterial pressure in childbirth, accompanied by complaints headache In the dark - the temporal area, violation of vision on the type of flushing of flies and glowing points before the eyes, outbreaks and not stopping hypotensive drugs (operating, nifedipine), without an effect from magnesial therapy.

These complaints indicate the increase in the severity of the state and require a speedy delivery. If the process of childbirth, by the time of a sharp deterioration of the state, has achieved dyghe, then you need to accelerate the wax period by affordable means.

On the part of the fruit

Close-up. If the testimony was not exposed to the cesarean section, then there may be episodemia in childbirth in order to reduce the risk of injury.

Premature childbirth. Premature childbirth, as a rule, are conducted with anesthesia, and then the epizotomy is performed. It also reduces the risk of injury to the premature fetus.

Acute hypoxia or decompensation of chronic hypoxia in childbirth, which began asphyxia in childbirth in the waiting period. If these urgent states have already arisen in the waiting period, when the fetal head is in a small pelvis, then the implementation of cesarean section is technically impossible. Reduce the risk of hypoxic lesion and accelerate the birth of a child by performing episotomy and applying obstetric tongs or vacuum extractor.

Multiple pregnancy. Sometimes multiple pregnancy serves as an indication for episotomy, especially if it is the first childbirth. The pelvic preview of the first fetus serves as a testimony to Cesarean section, however, it happens that the fever falls into the maternity hospital with a large opening of the cervix and started birth. In some cases, the execution of operation is technically impossible. In this case, the epizotomy is performed.

Threat of generic injury of the fetus. Generic injury can happen from any child, optionally large or in a pelvic preview. If the promotion of the generic paths deviates from the physiological norm, the risk of injury rises. If the baby comes up to the exit of the birth paths, not as it should be (the front view of the occipital presence, that is, the back up, the neck is bent greatly and is healing after the birth of the head), then the risk of damage is created cervical department Spine or jams (distation) of her shoulders. Communicative doctor obstetrician - gynecologist and midwife always see and control this process, so do not be afraid that somewhere there is a set for episiotomy (scissors, cotton balls), without the need to do no need to do.

Some abnormalities of generic activities. Rapid and fast childbirth, as can be seen from the name, proceed with high activity. Crotch fabrics do not have time to adapt and gradually stretch out under pressure from the fetus head. If an obstetrician - a gynecologist sees that the tissues are excessively stretched, thinned and threatened with a gap, then the episotomy is produced. If rapid childbirth proceeds without a threat to the crotch break, then the epizotomy "just in case" is not produced. Unlike childbirth premature fruit, when the tissue pressure should be reduced to the fetus head.

Pelvic prevention of the fetus. Birth in pelvic prediction refer to pathological. Sometimes this definition is formal, especially with repeated birth, and sometimes there is a need to expand the exit from the generic pathways. This is done if there is a threat of the difficulty of passing the head through the generic paths.

Contraindications for crotch cut

Contraindications to the conduct of episiotomy and perineotomy are not.

How is episotomy?

Preventive episodemation is rarely carried out (premature genera, pelvic presence of the first fetus and other individual states), produced a crotch cut with scissors at an angle of about 45º. For manipulation, local anesthesia is used (Novocain, Lidocaine).

Most often, episiotomy is performed in the waiting period without anesthesia. Let you not frighten the lack of anesthesia, in childbirth the level of pain and so high, stretched crotch is thin, and the manipulation itself is practically not felt separately from the common background. The fetal head quickly presses the edges of the cut and stops bleeding.

Perineotomy is now rarely done, despite the fact that this type of cut heals well. It is made in the event that the crotch has already begun to rush down, towards the anus.

Does epiziotomy / perineotomy affect the child?

If episotomy / perineotomy is performed according to the testimony from the fetus, its influence is definitely positive. If the cutting of the crotch was performed according to the testimony from the mother, then the effect on the fruit is positive (the preeclampsia of the mother is dangerous for the fetus) or is absent (the crust of the perineum hurts only the mother).

Epiziorraphia / Perineorrafia

Epiziorraphia / Perineorrafia is the embedding of the cut on the perineum after dissection or break. This manipulation is performed under local anesthesia (novocaine, lidocaine), the seams are usually superimposed by non-repository threads on the skin and absorbing the vagina mucosa. Unsessing material (Silk, Croprag, Vikril, Kapron) provides a solid reduction of the edges of the wound and allows them to heal without the threat of discrepancies of the seams. Cutting threads (for example, frequently used for staging breaks, Ketgut) ensure the strength of the seam for a maximum of 10 days, but the mucous membrane is rich in vessels, it will grow much faster than skin cover.

How does the seam heal after the cutting of the crotch?

Seams after episiotomy and perineotomy heal about 10-14 days. The patient is experiencing an unpleasant sensation, suture pain, especially when walking, sitting on or camping in a large toilet, and it is normal.

The perisure is the following:

A long-lasting edema swelling, edema growth and the appearance of new pain (drilling), the asymmetry of the germ lip or perineum (possibly the formation of hematoma, that is, blood clusters in the subcutaneous fatty cell);
- appearance of discharge with an unpleasant odor (yellowish, purulent or bloody);
- increasing body temperature and general symptoms of intoxication (weakness, fatigue, drierness, lubrication in muscles and joints);
- Violation of urination.

In these cases, you need to immediately contact the gynecologist. During the daytime, you can contact the district acusser-gynecologist to its consultation, in the evening and night time and on weekends and holidays, contact urgent gynecology. With pronounced general symptoms of intoxication, high fever you can cause a team of ambulance, in other cases it is possible to independently appeal to the duty gynecological hospital.

Do not postpone the appeal with such complaints, symptoms are developing quickly. If at the beginning of the process it is possible to do with small interference, let's say, open the hematoma, then in the proceeding cases in the impoding the hematoma and the dissemination of the inflammatory process, the operation will be much more traumatic.

Why cut the crotch if it threatens the gap or the gap is already in the go?

Then that the cutting wound heals much better torn. In the case of stitching the cutting wound, it is easy to compare the edges of the wound defect and to take them as physiologically, the blood supply is rapidly restored, and the wound heals the primary tension (without suppuration and with minimal edema).

The edges of the cut wound are smooth and clear, and ripped uneven. Match the edges of the ripped wound is physiologically very difficult (sometimes these are flaps of fabrics, detachable muscles), healing is slower, the blood supply to the damaged area is restored longer, it is also possible to form a crotch deformation (with large gaps, especially if healing has passed with complications).

When remove the seams?

The seams take off about 7 - 8 days. Most often at this point, a woman with a baby is already discharged from the maternity hospital, so you should take the seams to go to your female consultation. If for some reason you stayed in the maternity hospital, then the seams will be removed in the postpartum separation.

Postpartum period. How to care for yourself?

Hygiene

It is necessary to wash with warm water with soap (try to wash only the skin of the perineum, without an active touch of the mucous membranes), in the direction in front of the back.

In the first few days (at least three days), it should be laughed every 2 hours and after each visit toilet, soap is used 1 - 2 times a day, the remaining arms are made simply warm water under the shower.

Such frequent irrigation is necessary in order to remove with the skin and seams of the Lochi (postpartum bloody, and then mucous - succulent allocations), which are highlighted quite active about 1 week (it is a reduction in the uterus after delivery, returning it to previous sizes).

Lochi is a nutrient medium for bacteria, so in heat and in the presence of a rich nutrition, they multiply with high activity. Wipe the crotch after washing follows with gentlewashing movements, use a towel that does not leave the villus (for example, a towel from the fabric, which is called "waffle").

For at least two months should not take baths, visit the baths and saunas, solarium. Thermal procedures can provoke not only the suppuration of the seams after episiotomy, but also lactostasis, mastitis and other postpartum complications.

Do not use factory strips at least the first days after delivery. They are convenient for use, but are equipped with air and moisture-proof elements that create a greenhouse effect and accelerate the growth and reproduction of bacteria.

Use tissue or gauze lining without cotton, throwing them after use. Either change postpartum pads every 1.5 to 2 hours.

If there is an opportunity, then some time go through the house without underwear, the seams in this case are dried, you sweat less, and the injured crotch skin is not annoyed.

Mode

It is impossible to sit on a solid surface and exactly 2 weeks on both buttocks. The first two days is better not to sit at all. You can feed the child lying, for this there are convenient positions. Then you can sit on the sofa or a chair with a half-one, so that the emphasis accounted for more on the thigh than on the buttock. Either use a special ring pillow, which can be bought in orthopedic pharmacies.

All these precautions are necessary in order to prevent the crotch and the discrepancy or deformation of the seams.

You can not raise 2 months anything harder your own baby. When lifting weights, intra-abdominal pressure and tension of the crotch tissues increases, the risk of discrepancies of the seams is very large.

Food

For the same reason as lifting weights, it is impossible to allow constipation. This in itself is an unpleasant phenomenon, and if there are seams, it becomes already dangerous.

All events that help prevent and stop constipation are described in the article "Stop after childbirth."

Sexual rest

The postpartum period is a very vulnerable state for a woman. The uterus is an open wound surface, so you can easily be infected. The flora of your partner (normal for it) may be unacceptable for you during this period. In addition to the inflammatory factor, it is dangerous and purely mechanical. When you have sex, the crotch stretches and the seams may disperse.

Therefore, it is necessary to temporarily limit sexual relationships, the minimum rest period is 6 weeks, and better than 8 weeks.

Gymnastics

After healing the cut and removal of seams, it follows about 2 months to observe the protective mode (limit the heavy loads, cycling and the like influences), with a complicated flow of healing this period longer, consult with your doctor.

And then you should start restoring the perineum tone, performing the exercises of Kegel. This complex with regular execution will help restore the elasticity of tissues, helps to fight urinary impairment (involuntary urine miscarriage with a laugh, cough) and prevents the swaps of the uterus and the vagina in the future (in the period after menopause).

Gymnastics Kegel

These are exercises for strengthening the muscles of the pelvic floor, developed by the American gynecologist Arnold Kegel in 1952. And since then the complex has not undergone significant changes. Positive aspects of the fulfillment of the complex are undoubted, the main thing to do it regularly. After uncomplicated vaginal delivery, you can start studying for 3 days.

In the case of the presence of seams on the perineum (in this case, it is not so important, after spontaneous breaks or episiotomy), it should be started at about 8 weeks.

If you really want to restore the perinee, then consult your gynecologist, perhaps 10-14 days after the removal of the seams can already be started.

Dates are given indicative, it all depends on the degree and depth of the rupture, the wellness of the healing of the seams, the presence or absence of complications.

Exercise "Pause".

During each urination, delay the urine stream for 10 to 15 seconds about 5 times in one urination. And repeat with each campaign to the toilet. Next, when you understand the strength and intensity of the muscles, you can repeat this exercise and without urination. This technique is convenient because you can perform it unnoticed for others, it does not require separate time. Start the gymnastics from this exercise, perform it for several days, and then add other techniques.

Exercise "compressing".

Maximum burning the muscles of the crotch as much as possible and immediately release them, repeat them several times in the fast pace. The more active the rhythm, the better for the blood supply of tissues. Start with a slower pace, speed it up, and then slow down again. To this exercise should be moved when you have already felt your intimate muscles with the "pause" exercise and learned them to manage.

Exercise "Fixation".

It is necessary to strongly squeeze the muscles of the crotch and keep them in such a state for at least 10 seconds, gradually you will increase the power of compression, which will not only help restore blood circulation in the muscles and mucous membranes, but will make your intimate life brighter.

Squats.

Squat with a straight back, legs are arranged on the width of the shoulders. You need to go so much as low as possible and also to slowly go. Start with a small one, then you will not be the next day with sick muscles and do not leave classes at the very beginning.

Exercise "Elevator".

The vagina as part of its wall contains muscles that are arranged with ring-shaped "floors", you need to try alternately to strain each floor, keeping up in this position every time. Direction from top to bottom and back. To this reception we must start after sufficient experience.

Exercise "Storm".

It is also based on the wave-like cutting of the muscles, only the muscles of the pelvic bottom are involved. "Wave" must pass in front of back.

Prevention of crotch breaks in childbirth

Births on time are already physiological prevention of breaks, as the hormonal background changes again, fabrics and all other organs and systems are preparing for childbirth, tensile tissue becomes better.

You can also perform an outer intimate massage using neutral oils. It is performed daily already on a diligent period of pregnancy, if there are no contraindications (low placenta, the regional presence of the placenta and others). As a result of massage, the fabric gradually becomes more elastic and softer.

Forecast

Epsotomy / perineotomy Private manipulation and forecast for the life and health of mother and baby are favorable.

Sometimes the doctor in the process of childbirth tells you that you need episiotomy, do not refuse to manipulate. If something is worried or you are not aware enough about this issue, ask the doctor. Sometimes this is the only chance to prevent a serious generic injury to a child or mother. After childbirth, do not forget about yourself, not only the baby requires attention. Watch yourself and be healthy!

The dream of every future mother is to give birth without gaps of the perineum and cervix. Tell how to get into the number of such lucky. And what exactly can break, and from which the state of the tribute paths depends.

Why skin can stretch

The human skin is completely permeated by a thick network of connective tissue elastic fibers. They are named so thanks to their ability to stretch themselves very much without breaks, and then again gradually shrink to the initial state. A typical example of a huge use of such a skin peculiarity is a pregnant tummy growing in the circumference sometimes up to 120 cm and again flattered in a few weeks after delivery. Now you know that the condition of the front abdominal wall depends not only on the power of the muscular press, but also from the content of elastic fibers.

What is torn during childbirth

Crotch

The crotch outside is the skin, about the wonderful elasticity of which we have already told. It is her who, if there is a threat of a break, a doctor who receives childbirth, cuts scissors. The dissection (episodemation) can be carried out towards the rectum (pink arrow in the diagram) or at an angle (green arrow). This is done in order to prevent the death of the crotch skin, in which the dieting tissues can even achieve the rectum, which is fraught with serious complications and long-term treatment.

After removing the baby, the doctor imposes a neat seam, which heals much faster than the natural gaps, leaving a thin rutter. The problem is that in the area of \u200b\u200bthe scar, elastic fibers are replaced with more coarsest collagen, which are not capable of stretching. During the following delivery, especially if the fruit is large or transferred, very high probability of the crotch break is on the head. Therefore, re-giving birth to the doctor usually makes skin incision again.

Vagina

The vagina is a mucous membrane. It has a folded surface painting when stretching and thus providing protection in childbirth when the head and the fetal head passes. Insulated breaks in this area, including small sexual lips, are more often superficial and small, and deeper - in a complex with a crotch skin injury.

Cervix

This is the deepest region of generic pathways exposed to severe stretching. This is a channel formed by circular muscles. When there are suddenly or excessive pressure on them, their heads of the fetus are possible to break different severity depending on its length. In the most difficult cases, tissue damage can "crawl" even on the body of the uterus.

In which situations there may be a break of tissues that make up the generic paths:

• when;
• in the discs of generic activity;
• with large fruit;
• under traumatic obstetric manuals: imposing weekends on the child's head, with a pressure on the belly of the mother during the bouts, with vacuum extraction;
• with a restless behavior of a woman during the revelation period of the cervix and in attempts.

How to avoid breaks during childbirth

Whether the female trips of the sex tract emerge, it is impossible to predict, because it depends on the set of circumstances. But it is possible to significantly reduce the risk of such trouble. There are several ways.

1. Massage of the crotch and mucosa of the vagina

5. Calm behavior and maximum crotch relaxation in childbirth

Soft fabrics are easier stretched than dense. Musculature of the uterus does not obey women's desires. It is impossible to stop the will to stop the batch started. But add a cervical circular muscles with a shorter tension, if you restlessly, scream and misunderstand. A child energized by the cutting bodies of the uterus will still move along the generic paths, overcoming more pronounced resistance. As a result, he will suffer, and the mother will have deep breakdowns. And if you do not strain and between fights, try to relax as much as possible, then the crotch fabrics will be much more complicated and can be stretched.

Probability to give birth without breaks increase Regular during pregnancy. Especially useful and. No less benefit will bring cycling or swaying in a sitting position on the phytball. In addition, the skin is less elastic if a lot of fluid accumulated in it, or there is a thick fat layer. Therefore, it is important and not allowing the appearance of edema.

The child's birth process is a real miracle, which is accompanied by unusual processes in the body of a woman. The preparation of a woman to pregnancy is quite popular, but preparing for childbirth is not less important. It is more complex and significant, because it is impossible to predict possible risks and necessary eventsthat will have to do during the birth period. Today we will analyze incisions during childbirth, as it is called when, under what conditions, why do it, and is it harmful to a child.

Anatomical characteristic of the cut

In science, such a procedure is called epiziotomy. It is allowed to do incisions during childbirth only in the second stage of the generic activity. This stage is characterized by finding a child in the exit of a small pelvis. In this place is the child's head, even if there is no fence, it does not go back, but remains in a small pelvis. This period is called a teething of the head, that is, the baby is already visible.

At the moment, in 95% of cases, an incision is used in the oblique line, towards the sedlicatical bugs. If you look at the child's head straight, then you need to make cuts of the painter in the left lower corner. The cut length is approximately 2 cm.

The remaining cases are characterized by a cut in a straight line to the anus. This method is more complex and does not apply without need in practice. This type of cut is already called perineotomy. The size and direction of the end during childbirth depend on the individual characteristics of the woman and the generic process. Note that due to the fact that the muscles are stretched and the skin is thin, the painkillers do not do. It does not feel pain of cut.

Advantages of surgical outbreak

Enclosure at childbirth, made by a doctor with surgical instruments, heals faster than the natural tissue break. This is due to the following:

1. The edges of the wound are smooth, they are easier to connect and impose seams.
2. Gales in vivo, as a rule, deep and slowly heal.
3. A nozzle is made by a specialist, it will not allow a deep divergence of tissues and create all the conditions in the future for healing.

Indications to Procedure

Despite the fact that the surgical incision during childbirth is a more optimal option than a natural tissue break, special readings are needed for the procedure:

1. Creating a direct threat of tissue break when the skin around the crotch becomes very thin, starts to glisten.
2. The large size of the fetus, which are installed in front of the birth, so inclination during childbirth is not an emergency, it is scheduled in advance.
3. Premature childbirth when risk is risk injury for a child.
4. Distation of the shoulders when the child's head was already outwarded, and the shoulders could not crawl due to large sizes.
5. If any obstetric operations are assigned during the birth period, it is also necessary to carry out the procedure.
6. The incision during childbirth is vital to reduce the second period of generic activities. It is necessary if it is increased arterial pressure, The toddler's heart disease is diagnosed, the second period lasts for too long.
7. Hypoxia fetus begins and actively develops when the child lacks oxygen.
8. The child is incorrectly located, it is in the pelvic area, it is called "pelvic prediction".
9. Muscle rigidity is a phenomenon in which the muscles are so weak that they cannot create a full-fledged push to enter the child.
10. With the inability of a woman to spend on their own.

Technology cut

The first and prerequisite of the outline during childbirth is time - it can be done only during the second phase of generic activity at the time of the maximum sweep. Before incision, you need to treat the fabric by an antiseptic. If the tissues are not stretched strongly and the procedure may cause pain, the injection of Lidocaine is made:

• The incision is carried out by surgical scissors. During the recreation period, there are one part of the scissors (blade), called the brush, is injected into the gap between the baby and the tissues. The direction you need to withstand this in which an incision will be made.
• The length of the cut should not exceed 3 cm, a very short incision may be ineffective, and a long hurt, leading to a rupture.
• The seam imposition at this stage does not happen, after the placenta, the doctor inspects the patient and the uterus, after which the seams already impose. Anesthesia is made before applying the seam. After childbirth, the incision is no longer done, he is only invented. The stitched place is processed by an antiseptic, on this procedure ends.

There are two main methods of imposing seams on the resulting cut. Consider each of them.

The overlay of the seams of layers

The embossing of the cut occurs, starting from the mucous membrane of the vagina, after they were sewn, go further. Immersible seams connect all cut muscular fabrics. The synthetic threads that are able to dissolve are used. Ketgut is a thread of an animal intestinal fibers, which is sometimes used to impose seams, in this case it is prohibited. It can cause allergies. Cosmetic seams are superimposed by the second layer, they are small and continuous.

Perineorafia on Shuta

The second way of imposing seams is perineoraphia on the joke. There is no division on the fabric, all the layers are connected immediately. The eight-shaped seams are superimposed, but there are already synthetic threads that are not absorbed. After the wound dragged, the threads just take out. This method is more dangerous: often there are inflammation and appearance of infections.

Recovery after surgery

Restoration in this area is very inconvenient, especially considering that the woman has a newborn, which requires constant care and protection. The inconvenience lies in the fact that in the genital paths there are constantly there are microorganisms that can get into the rink and cause inflammation. Link and constant processing are not possible. If there were no inclusions during childbirth, you need to abandon the sedental position, otherwise the seams will disperse. By general rule It is forbidden to sit 2 weeks, but everything is individually, depending on the level of regeneration and the depth of the cut. The term can last up to 4 weeks. It turns out only the positions are allowed lying and standing.

Healing seams

The knuris is healing about 5-7 days if the area is processed correctly and the recommendations are not violated, the physician data is not infected. After the end of the first week, from the moment of the imposition of the seams, the doctor removes surface seams and checks the state of the scar. During the healing period, you must adhere to the following rules:

1. Daily processing of seams - midwives in the maternity hospital, as a rule, are treated with green, while assessing the state of a young mother.
2. After the shower, it takes some time to lie down naked to make a natural diesel engine, otherwise it is possible to apply infection. You can wipe the seams only with wrapping movements with clean material.
3. After each trip to the toilet, it is necessary to rinse the place with a weak solution of manganese.
4. Apply hygienic gaskets and change them every 2 hours.
5. It is impossible to raise anything heavy, the only exception is the child, it is impossible to touch him harder.
6. To drink a lot of water.
7. Training muscles with the help of kegel exercises.

Complete recovery occurs 2 months from the date of the procedure. Pay attention to the photo of the outbreak during childbirth, it shows how it should look. You need to carefully treat your health and with the emergence of any ailments to contact the doctor. It is about complications that will be on speech.

Effects

Not everything goes so smoothly, as I would like, and if there were no inclusions during childbirth, and errors were made during the recovery period, there may be complications:

1. The swell edema, which is treated with ice. It is superimposed in place of the cut, an anesthetic is additionally applied.
2. The discrepancy of the seams can occur due to seating poses or heavy loads. In this case, new seams are superimposed and the treatment process begins with scratch.
3. Increase infection in the wound, the treatment of which is possible only with the reception of antibiotics. If the conditions are favorable, then the seams are removed and the wound drainage occurs, this is the removal of pus and liquid.
4. The appearance of hematoma - in this case, you need to immediately remove all the seams and clean the wound from the pus, rinse the disinfection tool, assign the course of antibiotics and begin to be treated.
5. Pain during sexual intercourse. It is unpleasant, but quite normal feeling, in women for the first three months there are pains during the period of intimate communication. In about a year, complete recovery comes.

Birth is not always a pleasant process, but their result is a small lump of happiness - makes you forget even the most severe pain in the fights and other terrible details from Rodzala. According to some reports, each fifth woman remembers only the postpartum seams that appear because of the cuts in childbirth. It is not worth confused by these concepts, because they differ very much from each other. What is the difference - the answer is obvious: the gap arises by itself, and the incision is made by doctors with the help of special tools, and in different ways.

Enclosure: When is it necessary?

The most important reason for which the doctor can make an incision is the threat of spontaneous breaks, and they in turn arise for their reasons. For example, with fast and child, "breaks out" to the outside, and the crotch does not withstand such a pressure and begins to break, while it first fits, then shines, swells and whites. In this case, there is a cut, because, as you know, the smooth edges of the wounds are healing better, and the imposition of seams in this case is simplified (uneven edges of the ripped wounds to sew much more difficult).

Naturally, this is not the only reason to be cut. Especially since even the doctors will not "wait for" the symptoms of the gap, if there are probable reasons for their appearance. These include the bad elasticity of the muscles of the perineum, which is almost always observed in women over 35 years old (especially at primible). The cause of possible breaks (and therefore probable cuts) is also a developed muscles of the perineum, which is always found in women athletes.

It is almost always a cut in childbirth at in order to simplify the yield of the baby's head (after all, the born buttocks are less than the head, therefore the crotch is not ready for new stretching).

Doing the incision also when there is a need to shorten the expulsion of the fetus, if the protracted generation process threatens health or mother or baby. The same incision is done if there is a need to impose a vacuum extractor or tongs.

Enclosure during childbirth: how do it?

The fact that we all are so accustomed to call the incision, in the medical "slang" has its name: episiotomy or perineotomy. These two concepts differ in the way of the crotch dissection. With perineotomy, the cut is made by scissors towards the rectum down from the vagina (by the way, they are rarely done, only in the most extreme cases due to the danger of breaking and the rectum itself). The episiotomy is a cut of the diagonal from the vagina (either one or another).

Many women are interested in: Does this procedure require anneasiating? In fact, the crotch fabrics do not have blood supply, and therefore painful sensitivity, as such is not. Yes, and incision is an emergency operation where there is to anesthesia. Doing the incision most often in the very teething of the fetus head, then this "chic" is not even caught. The blood loss during the cut is minimal, so nothing terrible will happen to you. And only after the birth of the placenta, the doctors will take care of your wound, putting the seams on it.

Incision during childbirth: how does it all end?

Just the imposition of seams and care and ends both episiotomy and perineotomy. Usually sew the incision by self-sessive threads, so these wounds do not require any special care, neither additional operation at which you need to remove the seams. The main condition for the rapid and good wound healing is observing personal hygiene. Previously, seams to all women in the maternity hospital were treated with ordinary green. Today they are not recommended to "bake", but better to "venture". After each hike in the toilet should be "bathe" in front of the movement in front of the back, that is, from the pubis to the rectum to avoid contacting the microbes into the wound. Wipe the crotch is not recommended - it is better to lie down to its full drying and only then wear pants with a gasket (gasket to the way should also be changed every 2 hours, regardless of its filling).

After breaking and cuts, a woman for a long time (at least 10 days) can not be sitting. It is possible to feed the baby and relax only half a walk or lying, and then gradually sit on the ass. Also with caution you need to "walk in large". Perhaps the doctor will prescribe laxative candles to avoid pressure on the stitched wound.

If you ignore something from the above, it is likely that your wound "picker" infection is inflated and then you have to swallow pills (perhaps even antibiotics) and smear seams with all sorts of many years. However, usually, it is precisely the seams after cuts, they heal almost imperceptibly, and most importantly painlessly.

Is it possible to avoid?

Doctors approve: avoid cuts is not always possible, but it is likely. And the method is very simple and banal - gymnastics. If you systematically perform exercises that are aimed at increasing the elasticity of crotch tissues, the risk of breaks and cuts is sharply reduced.

The so-called kegel exercises are the simplest and efficient:

• Strain the muscles of the crotch, slowly count to three, then relax. You can also hush the muscles and hold them in this state up to 20 seconds.
• Helm the muscles a little bit (as if climbing the elevator, the 1st floor), hold 3-5 seconds and continue the rise, clamping a little stronger (2nd floor), holding and gradually achieve your limit. Down "Go down" as stages, lingering for a couple of seconds on each floor.
• Strain and relax muscles as quickly as possible for several minutes.
• From time to time, be worried about how when defecated.

By the way, you need to perform these exercises and in the postpartum period.

Do not be lazy! Good luck!

Especially for - Tanya Kivezhdiy