of Higher Degree Perineal Lacerations Scott Ridell MD Assistan Professor Department of Obstetrics Gynecology University of South Florida Morsani College of Medicine I have no significant ID: 953441
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{ Episiotomy and Repair of Higher Degree Perineal Lacerations Scott Ridell , MD Assistan Professor Department of Obstetrics & Gynecology Universi
ty of South Florida Morsani College of Medicine ï I have no significant financial conflict of interest Disclosure ï Introductions ï Didactic r
eview of episiotomy ï Simulation and practical ï Debrief Agenda ï Understand the indications for episiotomy ï Review episiotomy technique an
d repair ï Perform simulation skills training of episiotomy and repair ï Debrief Objectives Anatomy of Perineum Anatomy of Perineum ï Techni
que used for delivery of fetus for many centuries ï First reported in the United States in 1852 ï J.B. DeLee popularized the episiotomy in early
1900s ï Became routine practice in the 20 th Century ï Initially began as more a mediolateral approach but transitioned to midline approach by
1950s - 1960s ï Routine practice of episiotomy begins to be questioned in the 1980s leading to decreased frequency of use and todayâs practice
of episiotomy with indication Episiotomy: Historical Perspective ï Insufficient evidence for establishing criteria/recommendations regarding per
formance of episiotomy ï Clinical judgment is the best guide ï Has been used to shorten second stage of labor ï Has been used in providing p
erineal protection Episiotomy: Current Practice and Indications ï Mediolateral ï Midline Episiotomy Episiotomy ï Ensure adequate anesthesia ï
Protect the fetal head or presenting part by inserting the index and the middle finger into the vagina ï Incise the perineum using scissors
Episiotomy: Procedure Episiotomy: Repair Episiotomy: Mediolateral Repair ï Bleeding ï Extension of episiotomy ï Infection/breakdown of wound ï
Pain ï Dyspareunia Episiotomy: Complications ï âThe best available data do not support liberal or routine use of episiotomy. Nonetheless,
there is a place for episiotomy for maternal or fetal indications, such as avoiding severe maternal lacerations or facilitating or expediting diff
icult deliveries.â Episiotomy: ACOG Position ï Risk factors: ï Prior extensive laceration ï Fetal macrosomia ï Post - term gestation ï
Operative vaginal delivery ï Precipitous delivery Higher Degree Perineal Lacerations ï Repair is similar to episiotomy repair ï Ensure adequa
te exposure and review extent of laceration Higher Degree Perineal Lacerations 1. Episiotomy . I. Ling, Frank W. II. American College of Obstetr
icians and Gynecologists . III. Title. [DNLM: 1. Episiotomy. WQ 415 H163e 2007 ] 2. Netter RH. Atlas of human anatomy. 4 th ed. Philadelphia [PA]
: Saunders Elsevier; 2006. 3. Beckman CRB. Obstetrics and Gynecology. 4 th ed. Baltimore [MD]: Lippincott, Williams and Wilkins; 2002. References Qu