Managing Complications in Pregnancy and Childbirth: - IAWG

P-84 Repair of vaginal and perineal tearsFIGURE P-46Exposing a perineal tear• Apply antiseptic solution to the area around the tear (page C-22).• Make sure there are no known allergies to lignocaine or relateddrugs.Note: If more than 40 mL of lignocaine solution will be needed forthe repair, add adrenaline to the solution (page C-39).• Infiltrate beneath the vaginal mucosa, beneath the skin of theperineum and deeply into the perineal muscle using about 10 mL0.5% lignocaine solution (page P-39).Note: Aspirate (pull back on the plunger) to be sure that no vesselhas been penetrated. If blood is returned in the syringe withaspiration, remove the needle. Recheck the position carefully andtry again. Never inject if blood is aspirated. The woman can sufferconvulsions and death if IV injection of lignocaine occurs.• At the conclusion of the set of injections, wait 2 minutes and thenpinch the area with forceps. If the woman feels the pinch, wait 2more minutes and then retest.Anaesthetize early to provide sufficient time for effect.• Repair the vaginal mucosa using a continuous 2-0 suture (FigP-47, page P-85):- Start the repair about 1 cm above the apex (top) of the vaginaltear. Continue the suture to the level of the vaginal opening;- At the opening of the vagina, bring together the cut edges ofthe vaginal opening;