Perineal Management and Episiotomy Practice in Chile

Episiotomy is a common intervention used during the second stage of delivery. Current use of this procedure is restricted to certain births due to several complications. Almost all births in Chile are delivered by a gynecologist or a midwife in the public or private health system where episiotomy is performed. The objective of this study is to identify strengths and weakness in aspects of perineal management and episiotomy practice among obstetric health care providers with the purpose of promoting practice assessment and updating skills and competencies. Design: Questionnaire-based-cross-sectional study. Method: Anonymous questionnaire applied to gynecologists and midwives of public and private hospitals, between October and December 2019 using the Instrument designed by Cornet et al. addressing questions such as affiliation, number of births/year, knowledge of anatomy, knowledge of episiotomy, knowledge of perineal tear, competence in perineal repair, and presence of expert in perineal trauma at their unit. Results: 189 surveys responded, 51% from midwives and 37.6% from doctors. 71% of total were trained at their medical or midwifery schools and 69% during postgraduate internships. Episiotomy practice criteria: 19% always in primigravida patients and 14,3% always in premature deliveries. Majority of professionals, 79.4% with less than 100 deliveries a year had incorrect answers about depth or sphincter tear prevention technique. Conclusions: The majority of professionals indicated insufficient training capacities in relation to episiotomy techniques. Undergraduate programs should strength training on this intervention, national guidelines must include routine episiotomy performance in order to unify criteria.

Absorbable synthetic versus catgut suture material for episiotomy repair

Background: Episiotomy is a planned surgical incision made in perineum during childbirth. The type of suture material used for perineal repair following episiotomy will have effect on the intensiy of the pain experienced by mother. The objective of the present study is to determine the effects of rapide vicryl and catgut suture material on the amount of short term pain experienced by mother and to assess the amount of analgesia used following episiotomy suturing.Methods: Women with episiotomy cut was divided into two groups: group A consisted of episiotomy repair with catgut and group B with rapide vicryl. Following episiotomy pain will be assessed by visual analogue scale.Results: In KIMS hospital Bangalore - there was significant reduction in short term pain by vicryl rapide compared to chromic catgut and the need for analgesia.Conclusions: Vicryl rapide is effective in reducing the morbidity associated with episiotomy repair. There was significant reduction in short term pain and the need for analgesia, with decrease incidence of wound dehiscence.

Use of pedicled dartos flap wrap around technique in elaborarted perineal repair of complex pelvic fracture urethral distraction defect

Objectives: To describe the use of a pedicled dartos flap between the pubic bone and bulbar urethra after elaborate perineal urethroplasty in complex pelvic fracture urethral distraction defect. This is to prevent the risk of entrapment of the anastomotic area within a fibrous scar and hence prevent the risk of urethral stricture recurrence. Our objective is also to theorise the entity of bulbar urethral entrapment to describe the trapping of the bulbar urethra by fibrosis after extensive bone resection in complex cases of pelvic fracture urethral distraction defect. Methods: Ten patients with complex pelvic fracture urethral distraction defect underwent perineal urethroplasty at our institution from 2017 to 2019. Urethroplasty was done using the elaborated perineal approach in the standard fashion. Pedicled fibrofatty tissue along with dartos from the scrotum was used to separate the site of urethral anastomosis from the bare pubic bone and fill the dead space. Results: All patients are asymptomatic with no stricture recurrence in follow-up. Conclusions: Vascularised pedicle flap should become an important tenant in the elaborated perineal repair of complex pelvic fracture urethral distraction defect. It provides an ideal option in this scenario by decreasing the risk of urethral stricture recurrence without adding morbidity and minimum extra operative time. Level of evidence: Not applicable.

The Effectiveness of Giving Cold Compress in Pain Reduction Intensity of Perineal Wound of Postpartum Mother

Perineal wound pain is very likely to cause problems for the postpartum mothers. In the process of childbirth often occurs perineal wound, for some cases, it will heal permanently, but if the wound is wide enough can be sutured to the perineum. Perineal repair not only giving some benefits, but also can cause pain. One way to deal is by applying non-pharmacological pain management, the way is by giving cold compresses in the form of ice bags, it will result smaller risk. The purpose of this study was to provide cold compress therapy in scars to reduce pain. Methods: Posttest only control group design. The population in this study was 30 postpartum mothers in Kanigoro Health Centers by using purposive sampling. The sample was 16 respondents. The independent variable was cold compress, while the dependent variable was pain in the perineal wound. The instrument used Standart Operating Prosedure. Results: Fisher Exact Probability Test shows p = 0.003 (a = 0.05). It could be concluded that giving cold compress could reduce the problem in perineal wound for postpartum mothers in the Kanigoro Health Center area. Along with this study, respondents are expected to actively ask questions, learn about problems during and after giving birth, especially not only learn about the technique of giving cold compresses to the perineum, but also about the provided comments.

EFFECT OF PERINEAL REPAIR AND MUSHAKADI TAILA MATRABASTI IN MANAGEMENT OF RECTAL PROLAPSE (GUDABHARMSA): A CASE STUDY

Rectal prolapse can present in a variety of forms and is associated with a range of symptoms including pain, incomplete evacuation, bloody and/or mucous rectal discharge, and fecal incontinence or constipa-tion. Complete external rectal prolapse is characterized by a circumferential, full-thickness protrusion of the rectum through the anus, which may be intermittent or may be incarcerated and poses a risk of strangu-lation. There are multiple surgical options to treat rectal prolapse, and thus care should be taken to under-stand each patient’s symptoms, bowel habits, anatomy, and pre-operative expectations. We propose an al-gorithm based on available outcomes data in the literature, an understanding of ano-rectal physiology, and expert opinion that can serve as a guide to determining the rectal prolapse operation that will achieve the best possible postoperative outcomes for individual patients. Mushakadi Taila Matrabasti will be given in Sushrut Samhita as a treatment1 with perineal repair. So, it is really needed to find a safe, easier, less com-plicating, cost effective and fruitful approach for the management of disease through Ayurveda. A 62year old male patient came to the hospital with chief complaints of protrusion of mass from the anus with mu-cous discharge, constipation since last 5 years. He was diagnosed as complete rectal prolapse. Considering the signs and symptoms of rectal prolapse, the treatment of rectal prolapsed was planned with perineal re-pair and Mushakadi Taila Matarabasti as per mentioned in the treatment of Gudabhransha by Aacharya Sushruta.

Planning, construction and use of handmade simulators to enhance the teaching and learning in Obstetrics*

Objective: to describe the development process and present the results of a pilot study on the use of low-cost handmade simulators for teaching and learning Obstetrics. Method: presentation of 3 low-cost simulators designing, based on educational needs identified in real-world training contexts. The developing process is presented in detail and each simulator was tested and re-tested, being submitted to improvements until their final version. The simulators presented are: delivery simulator shorts, Neoprene uterus for postpartum hemorrhage management, and perineal repair simulator. A pilot study was carried out to evaluate the perception of apprentices through a structured questionnaire, using the Kirkpatrick evaluation model. Data were descriptively analyzed. Results: the respondents (31 apprentices) positively evaluated the simulators, perceiving significant gains in theoretical knowledge, ability to solve clinical problems and decreased anxiety to deal with situations similar to those simulated. Conclusion: low-cost, handmade simulators are feasible and effective, resulting in positive learner evaluations. Their availability as open technology allows the dissemination of their use.