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Episiotomy under local anesthesia
EPISIOTOMY
UNDER
LOCAL ANESTHESIA
SIDNEY VERNON, WILLIMANTIC,
A
M.D.
CONN.
PROCEDURE that Iessens the danat the edge of the vuIva near the fourchette, ger or difhcuhy of chiIdbirth and at preferabIy at the time the fetai head causes the same time tends to Iower the buIging of the perineum. A 20 gauge 2 inch costof medica care is worthy of serious conneedIe is then pIaced on the syringe and sideration. The majority of Iabors, at home the needIe directed IateraIIy and downor at the hospita1 are attended by a singIe ward, injecting as it is advanced and drawn physician and a method that makes labor back to the skin. The needIe is again more eficient is bound to improve obstetric advanced aIong the vaginal waI1, with a morbidity and mortality statistics. finger in the vagina to guide the needIe and The desirabiIity of episiotomy is we11 prevent piercing the vagina1 mucosa. Inciknown. The child’s weIfare is improved and sion is made by a series of scissor cuts so the mother’s strength is preserved by this as to judge accurateIy the depth of incision operation whenever a rigid or disproporaIong the skin and the mucosa. BIeeding tionate perineum is encountered. A cIean is controIIed by cIamp and Iigature. The cut wound is more easiIy and effectively feta1 head is deIivered by encouraging repaired than a tear. The use of barbituvoIuntary efforts during a pain, KristeIIer rates sometimes makes voIuntary efforts expression or the use of Iow forceps. A difhcuIt or too feebIe to be effective in Beck binder to make voIuntary efforts getting the head over a resistant perineum. more efficient is of advantage. Episiotomy with Iow forceps then wouId WhiIe awaiting separation of the pIabe indicated. The increasing use of barbitucenta, the sutures are pIaced using No. 2 rates in obstetrics wiI1 probabIy make such chromic catgut. After the delivery of the instances more frequent. With a singIe pIacenta the sutures are tied and siIkworm physician in attendance, the difficuIty of gut is used to approximate the skin. The obtaining a desirabIe anesthesia wouId siIkworm sutures are pIaced deepIy and cause withhoIding from doing an episiotthen tied without tension. omy where indicated. Where “prophyNo deformity of the perineum after Iactic” forceps with episiotomy is practiced, heaIing was noted when the medioIatera1 barb&a1 narcosis with IocaI anesthesia incision was used. It is superior to median might be sufficient for the procedure and episiotomy as the ana sphincter is not thus the patient avoids the disadvantages needIessIy exposed to damage. Comment. The use of IocaI anesthesia of genera1 anesthesia. Where chIoroform or ether is used for such work the toxicity and for episiotomy is advised and described. It increases safety and decreases expense of postanesthetic discomfort are decidedIy detrimentaL DeIay of postpartum contracaccouchement. By removing the obstacIes of anesthesia the appIication of episiotomy tion and retraction of the uterus caused by for the genera1 practigenera1 anesthesia with consequent danger is simpIified of hemorrhage is obviated by the use of tioner deIivering a mother in the home. An easier appIication of a vaIuabIe procedure IocaI anesthesia. Technique. The medioIatera1 incision is and a consequent wider practice of perinea1 suture shouId improve the practice of used. Using a hypodermic needIe, and I per cent procaine, a bIeb is raised in the skin obstetrics.
100
UNDER
LOCAL ANESTHESIA
SIDNEY VERNON, WILLIMANTIC,
A
M.D.
CONN.
PROCEDURE that Iessens the danat the edge of the vuIva near the fourchette, ger or difhcuhy of chiIdbirth and at preferabIy at the time the fetai head causes the same time tends to Iower the buIging of the perineum. A 20 gauge 2 inch costof medica care is worthy of serious conneedIe is then pIaced on the syringe and sideration. The majority of Iabors, at home the needIe directed IateraIIy and downor at the hospita1 are attended by a singIe ward, injecting as it is advanced and drawn physician and a method that makes labor back to the skin. The needIe is again more eficient is bound to improve obstetric advanced aIong the vaginal waI1, with a morbidity and mortality statistics. finger in the vagina to guide the needIe and The desirabiIity of episiotomy is we11 prevent piercing the vagina1 mucosa. Inciknown. The child’s weIfare is improved and sion is made by a series of scissor cuts so the mother’s strength is preserved by this as to judge accurateIy the depth of incision operation whenever a rigid or disproporaIong the skin and the mucosa. BIeeding tionate perineum is encountered. A cIean is controIIed by cIamp and Iigature. The cut wound is more easiIy and effectively feta1 head is deIivered by encouraging repaired than a tear. The use of barbituvoIuntary efforts during a pain, KristeIIer rates sometimes makes voIuntary efforts expression or the use of Iow forceps. A difhcuIt or too feebIe to be effective in Beck binder to make voIuntary efforts getting the head over a resistant perineum. more efficient is of advantage. Episiotomy with Iow forceps then wouId WhiIe awaiting separation of the pIabe indicated. The increasing use of barbitucenta, the sutures are pIaced using No. 2 rates in obstetrics wiI1 probabIy make such chromic catgut. After the delivery of the instances more frequent. With a singIe pIacenta the sutures are tied and siIkworm physician in attendance, the difficuIty of gut is used to approximate the skin. The obtaining a desirabIe anesthesia wouId siIkworm sutures are pIaced deepIy and cause withhoIding from doing an episiotthen tied without tension. omy where indicated. Where “prophyNo deformity of the perineum after Iactic” forceps with episiotomy is practiced, heaIing was noted when the medioIatera1 barb&a1 narcosis with IocaI anesthesia incision was used. It is superior to median might be sufficient for the procedure and episiotomy as the ana sphincter is not thus the patient avoids the disadvantages needIessIy exposed to damage. Comment. The use of IocaI anesthesia of genera1 anesthesia. Where chIoroform or ether is used for such work the toxicity and for episiotomy is advised and described. It increases safety and decreases expense of postanesthetic discomfort are decidedIy detrimentaL DeIay of postpartum contracaccouchement. By removing the obstacIes of anesthesia the appIication of episiotomy tion and retraction of the uterus caused by for the genera1 practigenera1 anesthesia with consequent danger is simpIified of hemorrhage is obviated by the use of tioner deIivering a mother in the home. An easier appIication of a vaIuabIe procedure IocaI anesthesia. Technique. The medioIatera1 incision is and a consequent wider practice of perinea1 suture shouId improve the practice of used. Using a hypodermic needIe, and I per cent procaine, a bIeb is raised in the skin obstetrics.
100