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Episiotomies
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by an obstetrician. This is usually performed during the second stage of labor to quickly enlarge the aperture, allowing the baby to pass through. The incision, which can be done from the posterior midline of the vulva straight toward the anus or at an angle to the right or left (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is surgical suture, sutured after delivery. Its routine use is no longer recommended, as perineal massage applied to the vaginal opening, is an alternative to enlarge the orifice for the baby. It was once one of the most common surgical procedures specific to women. In the United States, as of 2012, it was performed in 12% of vaginal births. It is also widely practiced in many parts of the world, including Korea, Japan, Taiwan, China, and Spain in the early 2000s. Uses Vaginal tears can occ ...
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Perineal Massage
Antenatal perineal massage (APM) or Birth Canal Widening (BCW) is the massage of a pregnant woman's perineum – the skin and deep tissues around the opening to the vagina (or 'birth canal' – when a baby is in this passage), performed in the 4 to 6 weeks before childbirth, i.e., 34 weeks or sooner (Reference 7, as more births are occurring at around 28 weeks) and continued weekly until birth. The practice aims to gently mimic the 'massaging' action of a baby's head on the opening to the birth canal (vagina) prior to birth, so works with nature, to achieve the 10 cm diameter opening without using the back of baby's head, i.e., doing some of the hard work of labour (birth) before the start of labour, making birth less stressful on the baby and mother. The intention is also to attempt to: eliminate the need for an episiotomy during an instrument (forceps and vacuum extraction) delivery; to prevent blood loss (risk of Sheehan's syndrome) and tearing of the perineum during birt ...
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Vagina
In mammals and other animals, the vagina (: vaginas or vaginae) is the elastic, muscular sex organ, reproductive organ of the female genital tract. In humans, it extends from the vulval vestibule to the cervix (neck of the uterus). The #Vaginal opening and hymen, vaginal introitus is normally partly covered by a thin layer of mucous membrane, mucosal tissue called the hymen. The vagina allows for Copulation (zoology), copulation and birth. It also channels Menstruation (mammal), menstrual flow, which occurs in humans and closely related primates as part of the menstrual cycle. To accommodate smoother penetration of the vagina during sexual intercourse or other sexual activity, vaginal moisture increases during sexual arousal in human females and other female mammals. This increase in moisture provides vaginal lubrication, which reduces friction. The texture of the vaginal walls creates friction for the penis during sexual intercourse and stimulates it toward ejaculation, en ...
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Perineum
The perineum (: perineums or perinea) in placentalia, placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. The perineal raphe is visible and pronounced to varying degrees. Etymology The word entered English from late Latin via Greek language, Greek περίναιος ~ περίνεος ''perinaios, perineos'', itself from περίνεος, περίνεοι 'male genitals' and earlier περίς ''perís'' 'penis' through influence from πηρίς ''pērís'' 'scrotum'. The term was originally understood as a purely male body-part with the perineal raphe seen as a continuation of the scrotal septum since Virilization, masculinization causes the development of a large anogenital distance in men, i ...
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Perineal Body
The perineum (: perineums or perinea) in placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), including the perineal body and surrounding structures. The perineal raphe is visible and pronounced to varying degrees. Etymology The word entered English from late Latin via Greek περίναιος ~ περίνεος ''perinaios, perineos'', itself from περίνεος, περίνεοι 'male genitals' and earlier περίς ''perís'' 'penis' through influence from πηρίς ''pērís'' 'scrotum'. The term was originally understood as a purely male body-part with the perineal raphe seen as a continuation of the scrotal septum since masculinization causes the development of a large anogenital distance in men, in comparison to the corresponding ...
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Neonatal
In common terminology, a baby is the very young offspring of adult human beings, while infant (from the Latin word ''infans'', meaning 'baby' or 'child') is a formal or specialised synonym. The terms may also be used to refer to Juvenile (organism), juveniles of other organisms. A newborn is, in colloquial use, a baby who is only hours, days, or weeks old; while in medical contexts, a newborn or neonate (from Latin, ''neonatus'', newborn) is an infant in the first 28 days after Human birth, birth (the term applies to Preterm birth, premature, Pregnancy#Term, full term, and Postterm pregnancy, postmature infants). Infants born prior to 37 weeks of gestation are called "premature", those born between 39 and 40 weeks are "full term", those born through 41 weeks are "late term", and anything beyond 42 weeks is considered "post term". Before birth, the offspring is called a fetus. The term ''infant'' is typically applied to very young children under one year of age; however, defini ...
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Blood
Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood is composed of blood cells suspended in blood plasma. Plasma, which constitutes 55% of blood fluid, is mostly water (92% by volume), and contains proteins, glucose, mineral ions, and hormones. The blood cells are mainly red blood cells (erythrocytes), white blood cells (leukocytes), and (in mammals) platelets (thrombocytes). The most abundant cells are red blood cells. These contain hemoglobin, which facilitates oxygen transport by reversibly binding to it, increasing its solubility. Jawed vertebrates have an adaptive immune system, based largely on white blood cells. White blood cells help to resist infections and parasites. Platelets are important in the clotting of blood. Blood is circulated around the body through blood vessels by the ...
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Postpartum Pelvic Floor Dysfunction
Pelvic floor dysfunction is a term used for a variety of disorders that occur when pelvic floor muscles and ligaments are impaired. The condition affects up to 50 percent of women who have given birth. Although this condition predominantly affects women, up to 16 percent of men are affected as well. Symptoms can include pelvic pain, pressure, pain during sex, urinary incontinence (UI), overactive bladder, bowel incontinence, incomplete emptying of feces, constipation, myofascial pelvic pain and pelvic organ prolapse. When pelvic organ prolapse occurs, there may be visible organ protrusion or a lump felt in the vagina or anus. Research carried out in the UK has shown that symptoms can restrict everyday life for women. However, many people found it difficult to talk about it and to seek care, as they experienced embarrassment and stigma. Common treatments for pelvic floor dysfunction are surgery, medication, physical therapy and lifestyle modifications. The term "pelvic floor dysf ...
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External Anal Sphincter
The external anal sphincter (or sphincter ani externus) is an oval tube of skeletal muscle fibers. Distally, it is adherent to the skin surrounding the margin of the anus. It exhibits a resting state of tonical contraction and also contracts during the bulbospongiosus reflex. Anatomy The external anal sphincter is far more substantial than the internal anal sphincter. The proximal portion of external anal sphincter overlaps the internal anal sphincter (which terminates distally a little distance proximal to the anal orifice) superficially; where the two overlap, they are separated by the intervening conjoint longitudinal muscle. Structure Historically, the sphincter was described as consisting of three parts (deep, superficial, and subcutaneous). This is not supported by current anatomical knowledge. Some sources still describe it in two layers, deep (or proximal) and superficial (or distal or subcutaneous). Some of the muscles fibres decussate at the anterior midline and po ...
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Internal Anal Sphincter
The internal anal sphincter, IAS, or sphincter ani internus is a ring of smooth muscle that surrounds about 2.5–4.0 cm of the anal canal. It is about 5 mm thick, and is formed by an aggregation of the smooth (involuntary) circular muscle fibers of the rectum. The internal anal sphincter aids the sphincter ani externus to occlude the anal aperture and aids in the expulsion of the feces. Its action is entirely involuntary. It is normally in a state of continuous maximal contraction to prevent leakage of faeces or gases. Sympathetic stimulation stimulates and maintains the sphincter's contraction, and parasympathetic stimulation inhibits it. It becomes relaxed in response to distention of the rectal ampulla, requiring voluntary contraction of the puborectalis and external anal sphincter to maintain continence, and also contracts during the bulbospongiosus reflex. Structure The internal anal sphincter is the specialised thickened terminal portion of the inner circular ...
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Bartholin's Gland
The Bartholin's glands (named after Caspar Bartholin the Younger; also called Bartholin glands or greater vestibular glands) are two pea-sized compound racemose glands, compound alveolar glandsManual of Obstetrics. (3rd ed.). Elsevier. pp. 1-16. . located slightly posterior and to the left and right of the Vagina#Vaginal opening and hymen, opening of the vagina. They secrete mucus to Vaginal lubrication, lubricate the vagina. They are homology (biology), homologous to bulbourethral glands in males. However, while Bartholin's glands are located in the superficial perineal pouch in females, bulbourethral glands are located in the deep perineal pouch in males. Their duct length is 1.5 to 2.0 cm and they open into fossa of vestibule of vagina, navicular fossa. The ducts are paired and they open on the surface of the vulva. Structure The embryological origin of the Bartholin's glands is derived from the urogenital sinus; therefore, the innervation and blood supply are via the pu ...
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Ischial Tuberosity
The ischial tuberosity (or tuberosity of the ischium, tuber ischiadicum), also known colloquially as the sit bones or sitz bones, or as a pair the sitting bones, is a large posterior bony protuberance on the superior ramus of the ischium. It marks the lateral boundary of the pelvic outlet. When sitting, the weight is frequently placed upon the ischial tuberosity. The gluteus maximus provides cover in the upright posture, but leaves it free in the seated position.Platzer (2004), p 236 The distance between a cyclist's ischial tuberosities is one of the factors in the choice of a bicycle saddle. Divisions The tuberosity is divided into two portions: a lower, rough, somewhat triangular part, and an upper, smooth, quadrilateral portion. * The ''lower portion'' is subdivided by a prominent longitudinal ridge, passing from base to apex, into two parts: ** The outer gives attachment to the adductor magnus ** The inner to the sacrotuberous ligament * The ''upper portion'' is subdiv ...
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Frenulum Of Labia Minora
The frenulum of labia minora (fourchette or posterior commissure of the labia minora) is a frenulum where the labia minora meet posterior (anatomy), posteriorly. Pathology The fourchette may be torn during Childbirth, delivery due to the sudden stretching of the vulval orifice, or during copulation. To prevent this tearing in a haphazard manner, obstetricians and, less frequently, midwife, midwives may perform an episiotomy, which is a deliberate cut made in the perineum starting from the fourchette and continuing back along the perineum toward the anus. Sometimes this surgical cut may extend to involve the perineal body and thus reduce anal sphincter function. Thus some obstetricians have opted to perform a posterior-lateral cut in the perineum to prevent this potential complication from occurring. The fourchette may also be torn in acts of violence wherein forced entry occurs such as rape. When the fourchette is torn, the bleeding which ensues sometimes requires surgical surgi ...
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