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Chapter-22 Repair of Tears: Vaginal, Perineal and Cervical

BOOK TITLE: Operative Obstetrics and Gynecology

Author
1. Kriplani Alka
2. G Sumana
ISBN
9788184485370
DOI
10.5005/jp/books/11088_22
Edition
1/e
Publishing Year
2009
Pages
8
Author Affiliations
1. All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, New Delhi, India; Menstrual Disorders Committee, FIGO, WHO-CCR, HRRC and Family Planning, All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, New Delhi, India; FOGSI 2016, Human Reproduction Research Center and Family Planning, All India Institute of Medical Sciences, New Delhi, India, All India Institute of Medical Sciences, New Delhi, India; WHO HRRC and Family Planning, New Delhi, New Delhi, India, All India Institute of Medical Sciences (AIIMS), New Delhi, India, All India Institute of Medical Sciences, Fortis La Femme and Adiva Women Care, New Delhi, India, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, AIIMS, Delhi, AIIMS, New Delhi, India, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, All India Institute of Medical Sciences, New Delhi, krip
2. All India Institute of Medical Sciences, New Delhi, sumana_gurunath@gmail.com, AIIMS, New Delhi, All India Institute of Medical Sciences, New Delhi, India, Delhi, India, Delhi
Chapter keywords
visualization, cervix, deliveries, fluid diet, biofeedback physiotherapy, hematoma, end-to-end repair, vaginal mucosa, risk factor, sphincter tear

Abstract

This chapter presents some evidence-based issues to aid better understanding and management of perineal tears. It includes understanding perineal anatomy and physiology, using standardized classification systems, recognizing perineal trauma at delivery, anatomic reapproximation of tissues, and preventing their occurrence. It can be classified as injury to vaginal mucosa not involving the muscle, injury to the perineum involving perineal muscles but not involving the anal sphincter, injury to perineum involving the anal sphincter complex, and injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa. Vaginal tears should be sutured with adequate attention to the apex. Anterior and posterior tears should be repaired keeping in mind the close relation to the urethra and rectum respectively. Before beginning to suture a cervical tear its extent should be clearly known and if the apex of the tear cannot be visualized easily, a suture is taken in the most accessible upper limit of the tear.

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