Managing Complications in Pregnancy and Childbirth: - IAWG

Repair of vaginal and perineal tearsP-87• Apply antiseptic solution to the tear and remove any faecalmaterial, if present (page C-22).• Make sure there are no known allergies to lignocaine or relateddrugs.• 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 rectum using interrupted 3-0 or 4-0 sutures 0.5 cm apartto bring together the mucosa (Fig P-50).Remember: Place the suture through the muscularis (not all theway through the mucosa).- Cover the muscularis layer by bringing together the fasciallayer with interrupted sutures;- Apply antiseptic solution to the area frequently.FIGURE P-50Closing the muscle wall of the rectum