Medicine an Surgery notes

Apr 24th, 2015
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REPAIR OF VAGINAL AND PERINEAL TEARSThere are four degrees of tears that can occur during delivery:-First degree tears involve the vaginal mucosa and connective tissue.-Second degree tears involve the vaginal mucosa, connective tissue and underlying muscles.-Third degree tears involve complete transection of the anal sphincter.-Fourth degree tears involve the rectal mucosa.Note: It is important that absorbable sutures be used for closure. Polyglycolic sutures are preferred over chromic catgut for their tensile strength, non-allergenic properties and lower probability of infectious complications. Chromic catgut is an acceptable alternative, but is not ideal. REPAIR OF FIRST AND SECOND DEGREE TEARSMost first degree tears close spontaneously without sutures. -Review general care principles (page C-17).-Provide emotional support and encouragement. Use local infiltration with lignocaine (page C-38). If necessary, use a pudendal block (page P-3).-Ask an assistant to massage the uterus and provide fundal pressure.-Carefully examine the vagina, perineum and cervix (Fig P-46, page P-84).-If the tear is long and deep through the perineum, inspect to be sure there is no third or fourth degree tear:-Place a gloved finger in the anus;-Gently lift the finger and identify the sphincter;-Feel for the tone or tight

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