|Minor Surgical Procedures in Remote Areas (MSF, 1989, 172 p.)|
|Chapter 5: uro-genital procedures|
Dissection of the perineum to enlarge the birth canal and to prevent a tear.
· Pushing for more than 30 minutes increases pain and suffering.
· Occipito-posterior, face or forehead presentation.
· All obstetric maneuver, forceps, ventouse and symphysectomy.
· Perineal anomalies, retractile scars from previous deliveries.
In general, it is preferable to repair an episiotomy rather than to suture a perineal tear.
The decision to do an episiotomy comes with experience.
Pair of sterile scissors (for example, Dauphin scissors or 16 cm pointed scissors).
After disinfection of the skin with chlorhexidine (+ cetrimide) (see table page 7), place the scissors between the presenting part and a line postero-lateral to the vulva, with the next contraction cut obliquely and posteriorly for approximately 4 cm.