Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NU2101 > Perineal Repair > Flashcards

Perineal Repair Flashcards

1
Q

what are the 6 layers of tissue of the pelvic floor?

A

*Pelvic peritoneum
*Visceral layer of fascia thickened to form pelvic ligaments which support the uterus
*Deep muscles encased in facia
*Superficial muscles encased in facia
*Subcutaneous fat
*skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the structure and function of the pelvic floor?

A

*Its muscles are arranged in two layers: superficial and deep
*It supports and maintains the anatomical position of the internal female reproductive organs
*It provides voluntary muscle control for micturition and defecation (pooing)
*It facilitates birth by resisting decent of presenting part, forcing rotation, allowing birth to happen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the superficial muscles?

A

ischiocavernosus, bulbcavernosus (bulbospongiosus in the second diagram) and transverse perineal muscles, the external anal sphincter and external urethral meatus (or sphincter).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the deep muscle layer?

A

deep muscle layer (called the levator ani) provide strength and are made up of three pairs of muscles: pubococcygeus, iliococcygeus, ischiococctgeus (coccygeus in the second diagram).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pelvic floor damage can have many consequences on the lower urinary tract?

A

*Urinary incontinence
*Urgency and frequency
*Slow or intermittent stream and straining
*Feeling of incomplete emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the Pelvic floor damage can have many consequences on the bowel?

A

*Obstructed defecation
*Functional constipation
*Faecal incontinence
*Rectal/anal prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is the Pelvic floor damage can have many consequences on the vaginal?

A

*Pelvic organ prolapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is the Pelvic floor damage can have many consequences on pain?

A

*Chronic pelvic pain
*Pelvic pain syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the Pelvic floor damage can have many consequences on sexual function?

A

*Dyspareunia (painful sexual intercourse)
*Orgasmic dysfunction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the vestibule?

A

The vestibule is the part of the vulva between the labia minora into which the urinary meatus and vaginal opening open. It is almost like “the wall” between the 2 labial minora.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the fourchette?

A

The fourchette. This is a very important landmark in perineal repair. It marks the end of the vaginal wall suturing and where you should start the suturing of the muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what is the labia minora?

A

It is a very important landmark in perineal repair. Labial tears or grazes are common and it is a very sensitive area.
Labial tears or grazes are common and it is a very sensitive area. The labia minora joins at the clitorial hood, but the hood (also known as prepuce) is the skin that covers the head of the clitoris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the perineal body?

A

is the space directly between the end of the vulva and the anus. It is where the perineal muscles are located. If you do not repair this correctly, it can lead to multiple pelvic floor problems.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the hymenal remnants?

A

They are visible at both sides of the introitus. They are like small “flaps” of tissue, like extra skin in the area. However, you do not need to bring these together when suturing. It is part of the tissue that remains after the hymen broke. It will help you locate when you are reaching the vaginal opening and almost at the fourchette.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what are the landmarks in the process of perineal repair?

A
  1. Locate the apex of the tear (where the tear starts)
    1. Suture the vagina wall until you reach the hymenal remnants.
    2. By approximating edges of the vaginal opening, you form the fourchette. This marks the end of your vaginal wall suturing.
    3. Then, repair the muscles to form the perineal body
    4. Repair the skin.

Apex of the tear - hymenal remnants - fourchette - perineal body (muscles) - skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

summary of performing a perineal repair?

A
  • Identify the level of trauma and what muscles are involved.
  • Get the anchor stitch 1 cm above the apex (first stitch)
  • Then a continuous stitch down the vaginal wall up until where your hymenal remnants are.
  • At this point you want to bring the hymenal remnants together but not sutured.
  • If they hymenal remnants align then you have done the posterior wall correctly.
  • Second part - perineal muscles which is another continuous stitch. You might need to do two layers to get the skin together.
  • Once you get to the bottom you then do sub particular back up to the hymenal remnants. Unless the women has very frail tissue.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is a first degree tear?

A

affecting the external skin or vaginal wall, but with intact perineal muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a second degree tear?

A

ffecting perineal muscles but not the anal sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is a third degree tear?

A

affecting the anal sphincter complex, with two types

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is a 3A tear?

A

less than 50% of the external anal sphincter is torn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is a 3B tear?

A

more than 50% of the external anal sphincter is torn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is a 3C tear?

A

when both internal and external anal sphincter are torn

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is a fourth degree tear?

A

the anal sphincter is completely torn, affecting the anal epithelium too

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what are episiotomy indications?

A

Episiotomy should only be performed under very restricted situations, and always after gaining the woman´s consent and ensuring adequate analgesia is in place.

Episiotomy indications are:
* Instrumental birth
* To expedite birth due to fetal distress (only if head crowning)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

when is the ritgen manoeuvre practiced?

A

the hands are placed in the perineum from the moment the head is crowning (when the size of head visible is similar to the palm of your hand).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

how is the ritgen manoeuvre performed?

A

dominant hand is placed in the perineum, with the thumb and index applying gentle traction on both sides of the perineum, not on the fourchette.
Your other hand is placed on the head, to slow down the extension of the head in an attempt to prevent trauma in the anterior part of the vulva.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

how do you perform an episiotomy?

A
  1. To insert the local anaesthetics you should vision the line of the episiotomy.
    1. insert two fingers into the vaginal to protect fetal head.
    2. Using the syringe insert the needle at the fourchette 4-5 cm deep.
    3. Pull back on the syringe to ensure you get no blood flashback
    4. As you withdraw the needle insert the anaesthetic
    5. Before fully withdrawing the needle, either side of the initial infiltration insert the rest of the anaesthetic. Making it more effective.
    6. The medial lateral technique is recommended, which is at an angle of 60 degrees away from the midline. Anything less may cut through anal.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

how do you apply a warm compress?

A

ds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

what is perineal massage?

A

Women are recommended to start this from 34-35 weeks, but keep in mind that this should NOT be performed by the midwife during the second stage of labour. Please note that only water-based lubricants are recommended. There are lots of oils and products in the market for perineal massage, but we do not have enough evidence to support those claims.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

what are the 2 main suturing techniques?

A
  • Continous non-locking for vaginal wall and muscle layer
    Continous subcutaneous for the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

what are the two type of knots used in suturing?

A
  • At the apex, using a surgical square knot
    At the end, using an Aberdeen knot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

what is first degree tear disruption of?

A

perineal skin or lining of the vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

what is second degree tear disruption of?

A

perineal skin or lining of vagina
perineal muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

what is third degree teat disruption of?

A

perineal skin and lining of vagina
perineal muscles
partial or complete disruption of anal sphincter

35
Q

what is fourth degree teat disruption of?

A

perineal skin or lining of vagina
perineal muscles
partial or complete disruption of anal sphincter
lining of anus and rectum

36
Q

what does the Preparation for assessment of genital tract involve?

A
  1. Explain to women what you plan to do and why, gain consent
    1. Ensure baby is safe and warm. Do not disturb mother and baby bonding
    2. Offer inhalation analgesia, and/or use the relaxation techniques
    3. Ensure good lighting
    4. Position women so she comfortable and genital sutures can clearly be seen
      Perform the examination gently and sensitively
37
Q

when to or not to suture 1st degree?

A

*First Degree: if the tear is not in apposition (where the tear would not heal in alignment)

38
Q

when to or not suture 2nd degree?

A

Second Degree: all muscle layer tears should be sutured. (if following this the skin is in apposition it may not require to be sutured)

39
Q

when to or not to suture 3rd/4th degree?

A

Third/forth Degree: will require suturing immediately in theatre under spinal anaesthetic
There is little evidence to support the suturing of skin, small scale studies have found no difference in healing, therefore the midwife should ensure the woman has opportunity to make informed choice

40
Q

what are the advantages of suturing?

A

quicker initial healing
better alignment
reduced urinary problems

41
Q

what are the disadvantages of suturing?

A

may or may not reduce pain while healing
*may need woman to be in lithotomy (difficult with pelvic girdle pain)
*may result in increased use of analgesia
Always document fully informed consent and all discussions

42
Q

what are the principles of perineal suturing?

A
  • Effective analgesia
  • Aspectic technique
  • Swabs and sharps
  • Needle holder
  • Alignment of the tissue
  • Cessation of haemorrhage
  • Reduce dead space
    Minimal suture
43
Q

what is the analgesia involved in suturing?

A

*Continue with epidural if in situ
*If no epidural or epidural ineffective, use regional anaesthetic to numb the perineum. Infiltrate the perineum using 20ml 1% Lidocaine
*Use nitrous oxide (Entonox) inhalation to facilitate infiltration where needed
*Following procedure non-steroidal P.R. suppository eg Diclofenac 100mg (Not for asthmatics)

44
Q

what is the aspectic technique of suturing involve?

A

It is imperative that suturing is an aseptic technique, we will practice this in clinical skills.
Equipment needed:
*Sterile suturing pack
*PPE: sterile gloves, full body gown/apron

45
Q

what are the important principles of suturing?

A

*Aseptic Non Touch Technique - we will practice this in skills
*Decontaminate hands/trolley first
*Gather equipment and set aside
*Decontaminate hands, put on apron
*Open sterile pack/liner
*Open equipment packs without touching inner wrapper or equipment and drop on to liner - your sterile field is important
*Decontaminate hands
*Put on sterile gloves and begin procedure
*Swab perineum (water) from top to bottom, using swab only once

46
Q

what should be done with the sharps and swabs in suturing?

A
  • All swabs and sharps should be counted before and after the procedure, then document in the notes.
  • Sharps include the suturing needle and needles used for infiltration etc
    Draw up aesthetic using aseptic technique
47
Q

where is the ischiocavernous muscle?

A
48
Q

where is the bulbocavernosus muscle?

A
49
Q

where is the central point of the perineum?

A
50
Q

where is the levator ani muscles?

A
51
Q

where is the vagina?

A
52
Q

where is the superficial transverse perineal muscle?

A
53
Q

where is the external anal sphincter?

A
54
Q

where is the ischiocavernosus?

A
55
Q

where is the deep transverse perineal?

A
56
Q

where is the superficial transverse perineal?

A
57
Q

where is the external urethral sphincter?

A
58
Q

where is the bulbospongosus?

A
59
Q

where is the vaginal opening?

A
60
Q

where is the perineal body?

A
61
Q

where is the external anal sphincter?

A
62
Q

where is the coccygeus?

A
63
Q

what makes up the levator ani muscles?

A

pubococcygeus and llilococcygeus

64
Q

where is the pubococcygeus muscles?

A
65
Q

where is the lliococcygeus muscle?

A
66
Q

where is the clitoris?

A
67
Q

where is the labia minora?

A
68
Q

where is the urethra?

A
69
Q

where is the hymenal remnants?

A
70
Q

where is the fourchette?

A
71
Q

where is the perineal body?

A
72
Q

how do you infiltration the perineum?

A
  • Anaesthetic (Lidocaine in a 20ml syringe) should be administered into the four aspects of the tear or episiotomy
  • Inset needle from point A to B, withdraw plunger to ensure not in a blood vessel
  • Slowly withdraw the needle while depressing plunger to administer anaesthetic (infiltration)
  • Do not remove needle but reverse to insert needle from point A to C – infiltrate as above
    Repeat from point D to B and D to C
73
Q

what does cessation of the haemorrhage and reduction of dead space involve?

A
  • You must stop the bleeding at each point of the repair to avoid continued haemorrhage between layers (dead space) which could result in haematoma or PPH
  • Bleeding vessels should be tied off
  • Bring tissue into apposition to reduce risk of haematoma and PPH
    However, ensure minimal suture material and knots to aid healing
74
Q

how do you use the needle holder?

A
  • Like an artery forcep but with groves to allow grip of the needle
  • Use the needle holder to remove the needle and attached suture material from the pack
  • The needle holder should be placed on the last third of the needle – closest to the thread at right angle to the curve of the needle
  • The holder is held by its shaft and the wrist used to guide the needle through the tissue
    Using a needle holder
75
Q

what 3 stages of is suturing technique undertaken?

A
  • Posterior vaginal wall
  • Perineal muscle layer
    Perineal skin A loose continuous stitch is recommended
76
Q

how do you tie an anchor knot?

A
  • Visualise the apex of the wound, above the apex insert the needle through the tissue using the needle holder
  • The knot is tied three times: two throws round the needle holder to the right, one throw round the needle holder to the left and one throw round the needle holder to the right again
  • In between each set of throws the loose end of the thread is caught in the needle holder and is drawn/pulled through the loops, pulling each end of the thread at 180 degree angle to each other
77
Q

what is step one of suturing involve?

A

Continuous Non-Locking Suture to Vaginal Wall

78
Q

what does Step One: Continuous Non-Locking Suture to Vaginal Wall involve?

A
  • Following your anchor knot cut off the short end of thread.
  • The next stitch is placed below and parallel to the first, entering and exiting at a 90 degree angle
  • Visualise the needle at the trough (split in middle of two edges of wound) to ensure dead space filled and prevent suturing anal mucosa
  • Continue suturing in this way at 1cm intervals until reaching the fourchette
79
Q

what is step 2 of suturing involve?

A

Continuous Non-Locking Suture to Perineal Muscle

80
Q

what does Step Two: Continuous Non-Locking Suture to Perineal Muscle involve?

A
  • If required continue along the perineal muscle
  • Take 1cm ‘bites’ of tissue and visualise the needle in the trough each time
    If the skin does not need sutured then a knot can be tied in the usual way and buried by cutting the short end and passing the needle directly up under the suture line to take the knot into the tissue. The long end then cut
81
Q

what does step three of suturing involve?

A

Suture the Skin with Subcuticular Technique

82
Q

what does Step Three: Suture the Skin with Subcuticular Technique involve?

A
  • Reverse the needle on the holder so the sharp end of the needle is pointing directly up
  • Use a subcuticular (just below the skin) stitch from the bottom of the tear, superficially along the edge of the tear, directly up in line with the tear on one side
  • The bite should be approximately the length of the needle
  • The next bite is taken on the opposite side of the tear directly opposite where the last stitch emerged
  • Repeat from side to side until the fourchette is reached
  • Retain a loop with the final suture, tie and knot and bury in the vaginal wall, trim ends of thread
83
Q

what does post suture involve?

A
  • Examine vagina and perineum to establish if in good alignment and bleeding has stopped
  • Insert one finger into the anus to ensure sutures have not gone through the rectal mucosa
  • Administer rectal analgesia
  • Remove drapes, woman’s legs out of lithotomy, cover and place sanitary towel
  • Count swabs and needles and dispose of equipment
84
Q

how do you correctly document suturing?

A
  • time/date
  • extent of tear (diagram),
  • position of woman (lithotomy)
  • amount of anaesthetic given suture
  • material order of repair and technique
  • examination of vaginal and rectum following
  • swab/needle count
  • analgesia following procedure
  • Care instructions given to woman
    Sign

NU2101 (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions