Perineal cut

Perineal cut variations

An episiotomy (or episiotomy , even episiotomy or Perineotomie called) is the cutting of the dam in the direction after the wife or other female mammals at birth , the birth of time towards the end of vaginal delivery to shorten and thus the risk of asphyxia of the fetus to encounter, for example in the case of a breech birth , and to prevent an imminent Hautzerreißung. Episiotomies are usually during a press woe set with scissors. During the previous contraction, a local anesthetic can be injected so that the woman does not feel the cut. The wound is sutured under local anesthesia after the birth .

Indications

The perineal incision in the expulsion phase (2nd stage of labor) is a common measure during childbirth . Possible indications are:

• Premature babies
• Delivery from breech position
• Signs of fetal stress
• Genital mutilation , because scar tissue cannot stretch and the opening might be too small

execution

Ridge cuts are made in three different directions:

• The median episiotomy is cut along the midline, the raphe perinei, towards the anus . Compared to the other variants, the wound has the best chance of healing. However, if the incision is further overstretched, it may tear further to the anus , which can lead to incontinence .
• The medio-lateral episiotomy is performed starting from the midpoint at a 45 ° angle and, due to the lack of delimitation by the anus, can be performed longer, which leads to greater space gain.
• The lateral episiotomy is performed at a 45 ° angle, but offset about 2 cm from the center. Due to the considerable destruction of the surrounding tissue and the long, painful healing process, this is no longer performed.

Advantages and disadvantages

A perineal incision is considered necessary to shorten a long labor process, for example in the case of a breech birth or in vaginal-surgical births such as vacuum or forceps delivery . Clinical studies have only proven a benefit for children for a few indications.

A benefit of a routine incision for the mother could not be proven. The WHO sees no justification for a routine perineal cut. According to one study, there is no evidence that a routine perineal incision can reduce the frequency of symptoms after childbirth ("Evidence does not support maternal benefits traditionally ascribed to routine episiotomy."). On the other hand, the disadvantage is pointed out that if the episiotomy had not been performed, no birth injuries or fewer birth injuries would have occurred. ("In fact, outcomes with episiotomy can be considered worse since some proportion of women who would have had lesser injury instead had a surgical incision."). A preventive intervention is of little use, if at all, but after the birth it can also lead to severe impairment in the vaginal and anus area. Some gynecologists consider preventive perineal incisions to have a positive influence on later uterine or vaginal subsidence ( Descensus genitalis ), but this - like the reduction of higher-grade perineal or vaginal tears - has not yet been proven by any of the studies carried out on this.

literature

• K. Hartmann, M. Viswanathan, R. Palmieri, G. Gartlehner, J. Thorp Jr, KN Lohr: Outcomes of routine episiotomy: a systematic review . In: JAMA. Volume 293, Number 17, May 4, 2005, pp. 2141-2148, PMID 15870418 .
• C. Dannecker, C. Anthuber, H. Hepp: The episiotomy. Limits, Indications and Benefits. In: The gynecologist. 12/2000. doi : 10.1007 / s001290050655 .
• G. Nitsche: Influence of the restrictive indication for episiotomy in the case of impending perineal rupture on urinary continence, dyspareunia and on urodynamic parameters in primiparae 6-12 months postpartum. A prospective and randomized study. Dissertation . 2005. (Link) .

Web links

Wiktionary: Dammschnitt  - explanations of meanings, word origins, synonyms, translations

• WHO, Regional Office for Europe: Joint Interregional Conference on Appropriate Technology for Birth. (Link)
• Wiebke Rögener: Mischief in the delivery room In: Süddeutsche Zeitung from October 25, 2007. Link ( Memento from April 4, 2008 in the Internet Archive )

Individual evidence

1. ↑ Sönke Müller: Memorix Emergency Medicine (= . Memorix ). 9th, updated edition, Thieme, Stuttgart 2011, ISBN 978-3-13-139939-7 .
2. ↑ Intrapartum care for healthy women and babies | Guidance and guidelines | NICE. Retrieved February 4, 2019 . 

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !