The rules which the doctor follows in protecting the perineum as the head advances, may be thus summarized.
1. Deliver the patient on her side. 2. Maintain flexion of head. 3. Delay extension of the head. 4. Give chloroform to retard delivery and to prevent precipitate delivery. 5. Deliver between pains, if possible, by Ritgen’s maneuver (modified). 6. Do episiotomy, if necessary.
Perineorrhaphy.—Lacerations of the perineum occur in about 30 per cent of all primiparas and in from 10 to 15 per cent of multiparas. They occur when the child is large or too rapidly delivered, and when the orifice is small or the tissues inelastic.
For convenience, the lacerations of the perineum are divided for description into three degrees.
The first degree involves only the fourchette and a small portion of the mucosa. It is rarely more than one-half an inch in depth and requires no attention except cleanliness by the nurse.
The second degree may tear a variable distance into the perineal body, sometimes so deeply as to expose the sphincter ani. It is usually on one side, but may appear on both sides, and be accompanied by prolongations into the vagina.
The third degree passes through the sphincter and sometimes well up the rectal wall. This is also called a complete tear.
The lacerations of the perineum which require sutures should be attended to at once unless the patient’s condition is critical. In such cases the repair may wait from twelve to twenty-four hours.
For this operation the nurse will assemble and boil for fifteen minutes:
2 pairs of scissors.