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An episiotomy is made from the fourchette (at the midline on the most posterior point of the vaginal
vestibule) to avoid injury to the labia and greater vestibular gland or duct.
The cut is made in a posterolateral direction rather than directly posterior, to avoid injury to the
external anal sphincter and anal canal.
Some small blood vessels are likely to be severed, with resultant bleeding requiring at least firm
pressure to the wound edges or clamping and ligature to a bleeding point. The transverse perineal
branch derived from the internal pudendal artery is the major branch particularly endangered.
If the cut is made too far into the ischioanal fossa, inferior rectal branches of the pudendal nerve and
internal pudendal artery are also endangered. These supply the external anal sphincter.
If the cut is directed too lateral, posterior labial branches derived from the pudendal nerve and internal
pudendal artery are endangered.
Each respective component of the wound is closed layer by layer to control bleeding and reduce dead
space (which would otherwise become occupied by haematoma). Local anaesthetic may be infiltrated
via the wound (if adequate anaesthesia has not already been provided).
The first stage is to repair the vaginal mucosa (including any lacerations) which also prevents internal
bleeding.
The second stage is the repair of the perineal body (including the bulbospongiosus and transverse
perineal muscles) which also provides most of the strength for the closed wound.
The third stage is the repair of the skin (and subcutaneous tissue) with special care that it is neither too
tight nor too loose, which may otherwise result in painful coitus.
Indication:
Made during childbirth to prevent tearing of vagina & tissues
Delay in 2nd stage of labour due to tight perineum, foetal / maternal distress with head on perineum
Breech deliveries
7.8. Describe, with the aid of a video, the steps of Digital per rectal (PR) examination ANM Pelvis
Dissection 46
https://youtu.be/fUwLRtJN4Aw
7.8.1. In a PR examination, describe the structures/spaces that can be palpated by the gloved index
finger
The fundus of the uterus (in a female) may be palpable if the uterus is retroverted or retroflexed. The
seminal vesicles (in a male) may be palpable if they are able to be reached.
Tenderness on the right may be elicited from an inflamed appendix if its tip is located in the pelvic
cavity.
2. Pudendal nerves can be blocked in Alcocks canal on either side to give regional anesthesia in
obstetrical forceps delivery