Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2
Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2
SECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 C ANAL SPHINCTER INJURIESCONCLUSIONINTRODUCTIONInjury to the perineum during vaginal childbirth affects millions of women. One half to three quarters of parturients undergo some degree of perineal laceration during vaginal childbirth. However, rates vary considerably by locale and provider (Low. 200 Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 0: Webb, 2002). Some lacerations occur spontaneously during delivery. Or. an obstetric provider may cut an episiotomy to increase the vaginal outlet sEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
ize to aid the birth. Either may result in both short- and long-term symptoms and complications. Initially, most women experience al least temporary dSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 ions include physical, psychologic, and social problems, which all may affect a woman's ability to care for her newborn and family (Sleep, 1991). The most severe perineal lacerations involve the anal sphincter, and these are termed obstetric anal sphincter injuries (OASIs). These tears and their con Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 sequences are described in detail throughout Illis chapter.Preventively, increasing data are available to guide health-care providers and patients inEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
selecting the optimal perineal strategy for each woman's delivery. No single strategy fits all patients, thus clinicians should devote time during antSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 ctations of pelvic floor function following delivery.In tills chapter, we review current literature and practices for antepartum, intrapartum, and postpartum perineal management, specifically, data regarding risks and possible benefits of episiotomy, repair of obstetric lacerations, and their short- Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 and long-term sequelae are presented.CLASSIFICATION OF PERINEAL LACERATIONStudies suggest that obstetricians may misclassify anal sphincter injuries.Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2
This is coupled with an increasing awareness of the association between OASIs and anal incontinence (Fernando. 2006; Sultan. 1995). For these reasonsSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 x. This updated system now contains internationally accepted nomenclature and is summarized in Table 20-1 and Figure 20-1 (Koelbl. 2009; Royal College of Obstetricians and Gynaecologists. 2007).TABLE 20-1. Classification of Obstetric LacerationsTear Type Injury DescriptionFirst degree Second degreeI Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 njury to perineal skin only Injury to the perineum involving the perineal muscles but not the anal sphincterThird degree 3a 3b 3cInjury involves analEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
sphincter complex Less than 50% of EAS is torn More than 50% of EAS is torn EAS and IAS are torn, but the anorectal epithelium is intactFourth degreeESECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 n: injur}- only to perineal skin. 2. Second-degree perineal laceration: injury to perineum involving the perineal muscles but not to the anal sphincter complex. 3a. Third-degree perineal laceration: less than 50% of the external anal sphincter (E AS) is torn. 3b. Third-degree perineal laceration: mo Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 re than 50% of the EAS is torn, but the internal anal sphincter remains intact. 3c. ’Third-degree perineal laceration: external and internal anal sphiEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
ncters arc torn. 4. Fourth-degree perineal laceration: injury to the perineum involves the entire anal sphincter complex and the anorectal epithelium.SECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 y than first- and second-degree lacerations. Moreover, in recent years, litigation related to long-term maternal consequences of OASIs has increased (Eddy. 1999). In the report by the National Health Service Litigation Authority (2012) entitled Ten Years of Maternity Claims. perineal trauma was list Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 ed as the fourth most common indication for obstetric claims in the United Kingdom during a 10-year span (Jha. 2015).EPISIOTOMY■Historic EvolutionEpisEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
iotomy is commonly performed in obstetrics and is among the most-debated procedures. Episiotomy refers to a surgical incision of the perineum usually SECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 delivery, and reduce the time for neonate delivery.Sir Fielding Quid (1742). a Dublin midwife, recommended episiotomy to hasten prolonged labor when the external vaginal opening was deemed too narrow. In the United States, the first report of episiotomy was almost 110 years later. Namely, Taliaferr Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 o (1852) used a scalpel to cut a 1-inch left mediolateral episiotomy to aid delivery and avoid a rectal tear in a 16-year-old eclamptic patient.In theEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
20th century, more women delivered in hospitals, and this was accompanied by an increase in episiotomy rates (Thacker, 1983). DeLee (1920) recommendeSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 d fetus. He believed episiotomy would preserve the pelvic floor and introitus, prevent uterine prolapse and rupture of the vesicovaginal septum and restore virginal conditions. Some also attribute women delivering in lithotomy position to the rise in episiotomy and OASIs during tills period. Dorsal Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 lithotomy is thought to place additional stress on the perineal body and lead to tears whether or not an episiotomy is cut (Bromberg. 1986; Thompson.Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2
1987).In the 1960s. rates of routine episiotomy decreased as opponents questioned its scientific benefits. Investigators argued that widespread use ofSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRIC Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 siotomy if adequately informed of the risks and benefits (Kitzinger. 1981; Thacker. 1983).■Current EpidemiologyPopulation-based studies from the United States report that episiotomy rates have declined and were approximately 60 percent in 1979. 31 percent in 1997. and 25 percent in 2004 (Frankman. 2 Ebook Cunningham and Gilstrap’s operative obstetrics: Part 2 009; Weber. 2002). A recent study of vaginal deliveries in more than 500 hospitals found that episiotomy rates continued to decline from 17 percent inEbook Cunningham and Gilstrap’s operative obstetrics: Part 2
2006 to 12 percent in 2012. That said, hospital-to-hospital variation remainsSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRICSECTION 3INTRAPARTUMCHAPTER 20Episiotomy and Obstetric Anal Sphincter LacerationsINTRODUCTIONCLASSIFICATION OF PERINEAL LACERATIONSEPISIOTOMYOBSTETRICGọi ngay
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