How to care for postpartum perineal tear?
Because the fetus compresses the perineum during delivery, the doctor will make a lateral perineal incision at the perineum during delivery, and there may be different degrees of perineal laceration during delivery, which may easily lead to postpartum perineum congestion and swelling. Postpartum lochia is constantly discharged from vagina. If we don't strengthen the nursing of perineum, it is easy to cause infection of perineum and reproductive system.
Local tearing occurs during normal labor, and it is usually stitched. Generally speaking, this local healing takes almost a week. The luckiest thing for a woman to have a baby is to meet an experienced midwife. The midwife will accurately estimate the size of your baby with her rich working experience, and advise you to have a natural delivery or caesarean section according to the size of your baby. If the baby is too big, it is not recommended to give birth naturally. If it is within the allowable range, it is recommended that pregnant women give birth naturally. Because the perineum is rich in blood vessels, the blood circulation is good, the blood flow is sufficient, and the wound healing ability is very strong. Less serious perineal wounds will not hurt in 3-4 days. If there is no infection, the severe perineal wound can heal in a week or so.
There are generally two kinds of wounds left by natural childbirth. One is some minor injuries caused by the collision between the baby's head or exposed part and vaginal tissue during natural delivery. The wound is small, sometimes it may need a small needle to stop bleeding, and it will heal itself after delivery without special care. The other is vaginal laceration, which is very big and deep. Clinically, the wound left by the size of the laceration, the damaged tissue or the lateral perineal incision is called the first, second or third degree laceration. It's serious, easy to get infected, and needs good care.
What about perineal tear?
There is no need to sew the rectal wall, so there is less chance of infection. It has its advantages: for example, the scar of rectal defect is wide, and the layered method is used, which has great suture tension and affects wound healing. It is suitable for diseases with short rectal wall fissure. For example, if the fissure is long and the mucosal flap covering the fissure needs to be long, then the blood circulation at the distal end is not enough. The steps are as follows:
Make an inverted V-shaped incision in the posterior wall of vagina, such as the lower ends of both sides of a semicircular incision, put the left index finger into the vagina outside the anal skin folds and depressions, use the big finger to pull the vaginal mucosa outward in the vagina with tissue forceps, cover the finger with gauze, and peel off the vaginal (vaginal) wall downward until the cracked end. In order to avoid the mucosal flap being too thin or perforated, we must be careful with this step. If the middle part of the mucosa is perforated, the previous work will be abandoned and the layered method can only be used again.
The broken end of the constricted anal sphincter can be found in the concave part of the anal skin fold. Firstly, the curved vascular clamp is inserted into the subcutaneous tissue to separate the gap; Then insert the tissue forceps into this gap, and strive to pull out the broken end of the sphincter at one time to avoid repeated pulling, resulting in little muscle fiber damage. Find the broken ends on both sides and pull them to the center line. Put a finger in the anus to see if the anal finger is tightened. Sphincter is sutured with 2-3 stitches of middle silk thread, and the sphincter can be sutured later, because the external opening becomes smaller after sphincter suture, which affects the suture of levator ani.