PERINEOTOMY (Greek perineos a crotch + tome a section, a section) — an episiotomy. It is carried out in labor with the preventive purpose and at some gynecologic operations.
To the item it was offered by G. A. Michaelis. Operation consisted in a section only of skin of a crotch. However at such section the entrance to a vagina extended insufficiently and usually in labor of a muscle and a fascia of a crotch were broken off. D. O. Ott in 1927 suggested to make a deep vlagalishchnopromezhnostny section, at Krom * except skin, are cut a muscle and a fascia of a crotch. He proved need of such section of hl. obr. the fact that, except visible gaps, there are still so-called hypodermic gaps at which skin as more elastic fabric remains it is whole, and are broken off a muscle and a fascia of a pelvic bottom that leads to omission and a prolapse of the uterus and walls of a vagina. Because of fear that at midsection of a crotch there can be the subsequent rupture of an outside sphincter of an anus, the epiziotomiya — a nadsecheniye of big vulvar lips on depth of 2 cm with one or on both sides was offered. Items prozvodit at childbirth most often at elderly primapara at threat of a rupture of a crotch, at operation of imposing of obstetric nippers, at pelvic presentation (in the latter case under local anesthesia of external genitals), and also at the beginning hypoxia of a fruit for acceleration of childbirth; in ginekol, practice in some cases at a fistulografiya and at an expanded vulval hysterectomy.
At P.'s carrying out the section is made only after it is established that the head or buttocks of a fruit are cut through. At height of an attempt the doctor starts P., the midwife holds a head or buttocks of a fruit at this time. Between a head or buttocks of ployets and a back wall of a vagina under 'control of fingers enter a branch of blunt scissors and on the centerline of a crotch make a section length apprx. 2,5 — 3 cm.
During the imposing of obstetric nippers when there is a danger of a complete separation of a crotch with disturbance of an outside sphincter of an anus, and also at a so-called low crotch it is reasonable to make a section from an anus aside. At childbirth it is not necessary to apply side P. in all cases since process of healing in this case proceeds worse, than at median the Item.
At a fistulorafiya if the vulval and vesical fistula is badly available to survey, operation is begun about side P. (Shukhardt's section). The surgeon (midwife) enters fingers into a vagina and delays aside a crotch then the section becomes towards a sciatic hillock. It is more convenient to make a section on the left side that allows to stretch a vagina considerably; in some cases resort to a bilateral section of a crotch. All bleeding vessels immediately sheathe.
Side P. is applied at an expanded vulval hysterectomy across Shauta — to Shtekkel at cancer of a neck of uterus (see. Hysterectomy ). At the end of operation the section of a crotch is sewn up with layer-by-layer separate catgut seams.
Bibliography: Bodyazhina V. I. Obstetrics, M., 1979; Malinovsky M. S. Operational obstetrics, page 62, M., 1974; P e of t of the p e of N to about A. I. Akusherstvo, page 625, Kiev, 1965; Coats P. M. and. lake of A comparison between midline and mediolateral episiotomies, Brit. J. Obstet. Gynaec., v. 87, p. 408, 1980; G 1 a s e n a p p K. H. Mediane contra mediolaterale Episiotomie, ein Verg-leich, Geburtsh. u. Frauenheilk., Bd 33, S. 7 37, 1973.
V. A. Pokrovsky.