What is perineotomy and when is it used during childbirth?

Although giving birth is an amazing experience, there can be difficulties. A perineotomy is a procedure that medical professionals occasionally do during labor to aid in a safer baby delivery.

A perineotomy is a tiny incision made in the perineum, the tissue that lies between the vaginal opening and the anus. This is done to facilitate the baby’s passage through the birth canal by widening it.

When labor is taking a long time and there is a chance of tearing, this procedure is typically advised, such as when the baby is in distress. In order to empower parents to make educated decisions during childbirth, it is critical to comprehend the indications for and timing of a perineotomy.

A perineotomy, sometimes referred to as an episiotomy, is a birth canal widening surgical incision made during childbirth in the region between the vagina and anus (perineum). This process is usually employed in specific circumstances where it is necessary to stop severe tearing, expedite delivery if the baby is in distress, or help with challenging deliveries, like those requiring the use of forceps. Although it is not usually done, in certain situations it can help protect the mother and child.

Features

The birth of the fetal head is an important and responsible moment, which can sometimes be overshadowed by purely physical difficulties – a discrepancy between the size of the exit from the vagina and the diameter of the head, as a result of which there is a possibility of spontaneous rupture of the perineum. If such a rupture occurs, the consequences can be very serious – sometimes not only the genitals are injured, but also the intestines, severe bleeding develops, a vaginal-rectal fistula. If such a delicate situation arises, obstetricians can use perineotomy during childbirth – a surgical dissection of the perineum of the median type. With an episiotomy, the incision is made from the center to the right or left side, diagonally. Perineotomy involves a straight vertical incision directed from the center of the perineum down to the anus. The length of the incision is 2-3 centimeters. This is where the main difference from episiotomy lies. In all other respects, the methods are no different, and therefore perineotomy is considered one of the types of episiotomy, giving it an honorable second place in the classification of types of dissection.

If necessary, the child can exit the birth canal more quickly thanks to this artificial perineum expansion. Additionally, the incision prevents ruptures, which improves postpartum recovery.

The difference between episiotomy and perineotomy is almost imperceptible during the rehabilitation process, because the rules for treating sutures and basic recommendations for women in labor with a mid-lateral (diagonal) incision and a straight (median) incision are almost the same. The name of the manipulation comes from the Greek perineotomia (in turn, this word consists of perineos – "female perineum" and tome – "cut"). It is used along with episiotomy and is a free choice of the doctor or obstetrician delivering the baby. That is, the method of making the cut is decided according to the situation. Although some studies show that with a vertical midline incision there is a higher risk of the rupture continuing down the incision – to the rectum. And therefore, a midline-lateral incision is considered more appropriate. But there are no clear instructions on this matter. Until recently, the manipulation was widespread in obstetrics. Almost every woman in labor was "cut". Today, according to the recommendations of the WHO and the Russian Ministry of Health, perineotomy is used less often and only if there are certain indications.

Indications

As already mentioned, earlier the incision was done for preventive purposes – to prevent perineal ruptures. Today, the view of the perineotomy and episiotomy has changed. The Ministry of Health recommends observation and waiting for the tactics. The medical staff can resort to surgical dissection only when there is a high probability of a gap during pathological childbirth. It may be necessary in the mid -section at the birth of a large baby, with a large diameter of the head or legs born. Typically, under such circumstances, a cesarean section is recommended, but a woman has every right to write a refusal and insist on natural births. If doctors need to apply forceps or vacuum-excess, there is also a need to expand the between the area surgically. Colloidal and thinned, heterogeneous scars from previous breaks or dissection can also be the basis for the median section. High crotch and rigidity have not been considered the grounds for indispensable perineotomy for some time.

If a woman has a medical condition that prevents her from pushing hard, she can still use this method (e.g., diseases of the eyes). Additionally, there are high expectations for the manipulation in the event that a child whose head is already at the vaginal exit is found to be in a state of hypoxia.

Technique of execution

Only during the pushing phase—neither earlier nor later—is the incision made. At the peak of the next push, the head should already be cut through and protrude by 3–4 centimeters. Take out surgical scissors with blunt ends. One end is inserted inside while the other stays outside during the space between pushing. The incision is made in a single motion at the height of pushing. The skin is the only thing that is cut.

It is advised to manually regulate the head’s birth rate in order to prevent additional incisional rupture. The baby is somewhat restrained with the palm if he is in a hurry.

• the perineum is treated with an antiseptic;
• measures are taken for pain relief (locally);
• the incision site is sutured with catgut threads, and silk surgical sutures are applied to the skin;
• antiseptic treatment is carried out again.

Antiseptic treatments are then repeated on a daily basis.

Complications

It can be quite challenging to care for the stitches on your own. This is not the most convenient location for the perineal area. However, the woman doesn’t need to worry while she is in the maternity hospital because medical professionals will take care of her. The husband can assist with this at home. Brilliant green and hydrogen peroxide should be used to treat the wound. By doing so, you can help it dry out and prevent bacterial infection.

Since inflammation is the most frequent side effect of perineotomy, extra attention needs to be given to treatment and care because the perineum wound cannot be continuously ventilated and is in direct contact with postpartum blood discharge.

Silk threads are typically taken out on days 6-7, and if there are no complications, full healing takes place in 3–4 weeks. Should the healing process take longer, the suture become compacted, lumps develop on it, or pus or ichor is expelled from it, you should see a doctor right away and get the care you need.

One other common complication is suture divergence. It can happen as a result of overly tight perineum, as well as from breaches of the motor regime’s rules and obstetric errors, which include improper suture technique or suture set selection. This shows up as increased pain and swelling, gaping of the wound at the site of divergence, and the return of serous or bloody discharge from the scar.

Re-suturing may be necessary for divergence only if fusion has not taken place over the majority of the incision’s length. In other instances, medical professionals cleanse the wound, apply antiseptic, and prescribe topical anti-inflammatory or antimicrobial medications (such as Levomekol). Healing happens by accident.

Antibiotics are needed to treat inflammation and suppuration, and surgery is needed to help prevent the formation of hernias, fistulas, and internal hematomas.

The woman’s complaints that it hurts to stand and walk at first are not regarded as a complication; discomfort and nagging pain are normal while the skin’s integrity and nerve endings are being restored.

A procedure called a perineotomy, sometimes referred to as an episiotomy, can help make childbirth safer for both the mother and the unborn child. In order to provide extra space during delivery, a tiny incision is made in the perineum.

Usually, this process is only taken when it is absolutely required. It may be advised in certain circumstances, such as when the infant is in distress or when the delivery is taking longer than anticipated and posing a greater risk to the mother and the child.

Perineotomy carries some risks, such as discomfort during recovery or infection, even though it can help prevent serious tearing. But most women recover well from the procedure if they receive the right care.

Making educated decisions during childbirth can help ensure a safer and more comfortable experience for both you and your child. This includes knowing when and why a perineotomy is necessary.

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