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Childbirth: episiotomy and episiorraphy - Parto Vaginal con Episiotomía: Episiorrafia

Enviado por " CONSULTORIO MÉDICO FLORES BUISSON " MÁNCORA- PERÚ...
URL: http://consultoriomedicofloresmancora.es.tl/ ...
Episiorrafia: es la reparación, mediante el uso de suturas, de la herida dejada por la episiotomía. Utilizamos sutura absorbible que se deshace sola y que no requiere ser removida posteriormente.
Se entiende por episiotomía a la realización de una incisión quirúrgica en la zona del perineo femenino, que comprende piel, plano muscular y mucosa vaginal, cuya finalidad es la de ampliar el canal "blando" para abreviar el parto y apresurar la salida del feto. Se realiza con tijeras o bisturí y requiere sutura. La episiotomía como técnica preventiva para evitar desgarros está contraindicada por la Organización Mundial de la Salud. Las episiotomías no previenen desgarros en o a través del esfínter anal ni desgarros vaginales. De hecho, los desgarros profundos casi nunca ocurren cuando no se realiza una episiotomía.
Desde los años 1960 las episiotomías han perdido popularidad entre obstetras y parteras en Europa y el resto del mundo. Un estudio nacional en EE.UU. por Weber y Meyn (2002) sugiere que el 31% de mujeres que tienen bebés en hospitales recibieron episiotomías en 1997, comparado con 56% en 1979.[1]

En América Latina la episiotomía se practica hasta en un 90% de los nacimientos hospitalarios,[2] en la mayoría de los casos sin el consentimiento de la madre. Es una de las razones de infecciones y mortalidad materna después del alumbramiento. En la actualidad en America Latina se reconocen más los procedimientos por cesárea, lo cual es escogido libremente por la madre en clínicas privadas.

Suture of episiotomy = episiorraphy. An episiotomy is a surgical incision through the perineum made to enlarge the vagina and assist childbirth. The incision can be midline or at an angle from the posterior end of the vulva, is performed under local anaesthetic (pudendal anesthesia) and is sutured closed after delivery. It is one of the most common medical procedures performed on women, and although its routine use in childbirth has steadily declined in recent decades, it is still widely practiced in Latin America and in Poland and India.
The primary rationale behind an episiotomy is related to the nature rather than the size of the tear. An episiotomy creates a primary intention wound which is easier and less painful to suture, causes less scarring and reduces the risk of infection compared to natural wounds. This is because the natural wounds are typically secondary or tertiary intentions which create poorly related wounds (ragged edges) and shearing between perineal layers slowing healing and increasing the infection risk

Many physicians use episiotomies because they believe that it will lessen perineal trauma, minimize postpartum pelvic floor dysfunction by reducing anal sphincter muscle damage, reduce the loss of blood at delivery, and protect against neonatal trauma. In many cases though, episiotomies cause all of these problems.[1] Research has shown that natural tears typically are less severe (although this is perhaps unsurprising since epistiotomy is designed for when natural tearing will cause significant risks/trauma)

Slow delivery of the head, in between contractions will result in the least perineal damage.[2]

Episiotomy is indicated if:

the baby's shoulders are stuck (Shoulder Dystocia) a bony association, though the episiotomy does not resolve this problem, it allows the operator more room to perform maneuvers to free shoulder from the pelvis.
There is a serious risk to the mother of second or third degree tearing
In some cases where a caesearean is not indicated but delivery is adversely affected
'Natural' tearing will cause an increased risk of maternal disease being vertically transmitted
Routine episiotomy is NOT indicated in evidence based practice
Large baby
rigid perineal muscles
When instrumental delivery is indicated
When a woman has undergone FGM (female genital mutilation) an anterior and or mediolateral episiotomy may be indicated.
Prolonged late decelerations or fetal bradycardia during active pushing.


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