Ok, in my minimal experience with suturing vaginas and perineums, here is what I have learned:
If it's superficial and not bleeding, and it comes together nicely when the woman's legs are shut, then you probably do not need any suture in it.
A vaginal pocket (small little gap at the vaginal introitus) usually closes nicely with a figure of 8. Or two of them.
Find the apex in the vaginal laceration, and work your way outward. Use a locking stitch.
2-0 vicryl on a CT needle is my favorite suture material for vaginal lacerations.
3-0 chromic on an SH needle heals best for periurethral lacerations.
The transverse perineal muscle looks like a sausage when it's lacerated. (Make sure you match the lacerated ends of the sausage back together!)
Knot tying is harder to do with wet gloves.
Staunch the flow of lochia with a tagged sponge/lap, so you can view the area to be repaired.
Sometimes you need three hands to suture things back together.
Suturing the superficial perineal skin back together is very rewarding. Everything looks so pretty again!
When in doubt about the depth of the laceration (a possible 3rd or 4th), call in the attending MD. After all, they are highly skilled surgeons. The same thought apply to a "what the heck??" laceration where you can't make heads or tails of what goes where. It bears repeating: OBs are great at surgery, thus, they are amazing at sewing things back together.
11 comments:
I lol'd at the "what the heck" laceration!
Yep, that about sums it up!
What's the protocol for repairing labial lacerations? Curious because of personal experience with a graze that resulted in a bisected labia.
no protocol, per se. You look at it, if it's very superficial (just skin), and it comes back together on it's own when her legs are closed, and it's not actively bleeding, you generally let it alone. If it's deep, long, bleeding -- suture it. Labial lacerations, I would do a very small needle, because that's a very delicate area!
Maybe because it was a nasty 2nd degree tear, but I had a wonderful surgeon suture my tear and even now 6 1/2 years later and another vaginal birth under my belt and I'm still pretty tender in that area.
Do you have any good resources for suturing? I will be getting my knot board soon :-)
Karyn - not any resources off hand -- but get some real suture, a piece of foam, some instruments (needle driver, forceps, scissors), and practice, practice, practice. I also will sit and just practice throwing my hand ties on suture. Kind of like making a friendship bracelet. Get the knot tying into muscle memory!
I went to the butcher, and bought a peice of pork with skin attached. Its not ideal, but warmed up to room temperature, it will do in a pinch....pardon the pun!
I went to the butcher, and bought a peice of pork with skin attached. Its not ideal, but warmed up to room temperature, it will do in a pinch....pardon the pun!
Always count your sponges if you need one for visualization. I had a retained sponge for 1 week PP because that wasn't my OB's protocol.
4.0 Polysorb is my personal favorite for peri-urethral lacerations.
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