Rather than using routine episiotomy , obstetrician-gynecologists should take steps to lower the risk for obstetric lacerations during vaginal delivery , according to a new practice bulletin released by the American College of Obstetricians and Gynecologists. According to the American College of Obstetricians and Gynecologists ACOG , perineal massage, either antepartum or during the second stage of labor, can decrease muscular resistance and reduce the likelihood of laceration. The bulletin also recommends the use of warm compresses on the perineum during pushing to reduce third- and fourth-degree lacerations. The guidelines also note that such prophylactic interventions may also be beneficial for women with previous OASIS during future pregnancies. The bulletin also provides recommendations on the diagnosis of lacerations, preferred suturing technique, the use of antibiotics at the time of OASIS repair, pelvic floor exercises and long-term monitoring.
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Read terms. Trauma can occur on the cervix, vagina, and vulva, including the labial, periclitoral, and periurethral regions, and the perineum. Most of these lacerations do not result in adverse functional outcomes. Severe perineal lacerations, extending into or through the anal sphincter complex, although less frequent, are more commonly associated with increased risk of pelvic floor injury, fecal and urinary incontinence, pain, and sexual dysfunction with symptoms that may persist or be present many years after giving birth.
The purpose of this document is to provide evidence-based guidelines for the prevention, identification, and repair of obstetric lacerations and for episiotomy. ACOG Clinical is designed for easy and convenient access to the latest clinical guidance for patient care. Figure 1. The anal canal. Reprinted from Mayo Foundation for Medical Education and research. All rights reserved. Retrieved April 20, Bulk pricing was not found for item.
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A new ACOG clinical management guideline has recommended that the procedure be restricted, although it did not issue any specifics about indications for use. The guideline attempted to put to rest two widely held beliefs about episiotomy -- that the procedure lowers the risk of incontinence by reducing pelvic floor damage and that it reduces the rate and severity of perineal lacerations. Nonetheless, the ACOG Practice Bulletin stated that there is not enough objective evidence to provide "evidence-based criteria to recommend episiotomy. The best available data, according to ACOG, "do not support liberal or routine use of episiotomy. Nonetheless, there is a place for episiotomy for maternal or fetal indications, such as avoiding maternal lacerations or facilitating or expediting difficult deliveries. The guideline noted that recent systemic reviews have estimated that an episiotomy is performed in about one in three vaginal births. In the U.
ACOG releases recommendations to lower risk for obstetric lacerations during vaginal delivery
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