Seams after the delivery: materials and technologies
They say that men like to tell how they were at war, and women - as they gave birth. Similarity between a battlefield and maternity hospital is not settled only by tendency to exaggerations which can be noticed in stories of veterans. It is possible to see one more analogy: after visit of maternity hospital as after a battlefield, young mothers quite often carry away fresh hems for memory. What hems when and where they arise what are and how to make these damages less painful and more esthetic - about it we and we talk are.
Seams after the delivery
Seams on a uterus neck are imposed by
at ruptures of a neck of a uterus during survey of patrimonial ways which is made right after childbirth. Gaps most often arise in typical places: on 3 and 9 “hours“ (if a uterus neck as it is accepted at obstetricians - gynecologists to present in the form of the dial of hours). Ushivaniye of such gaps does not demand anesthesia - after the delivery the neck of a uterus is insensitive to pain. Most often, the resolving sutural material - biological material catgut suture (it is made of a small intestine of cattle or sheep) or semi-synthetic threads is used: vikrit, PGA, kaproag. Seams can be separate (a number of short threads, each of which is fixed by knot) or continuous where it is knotted only at the beginning and the end of a linear gap. These seams do not demand special leaving in the postoperative period and do not give trouble.Seams in a vagina are imposed by
at ruptures of a wall of a vagina. For imposing of separate seams or a continuous seam the resolving materials are also used. It is more painful operation demanding anesthesia - local (Novocaine, Lidocaine) or the general (a short-term intravenous anesthesia). Seams of special leaving do not demand. The taken-in ruptures of a vagina can be moderately painful during couple of days after their imposing.Seams on a crotch are imposed by
in case of ruptures of a crotch in labor or its artificial section.
are Distinguished by ruptures of a crotch of three degrees: I - gap only skin of back soldering of a vagina; II - a rupture of skin and muscles of a pelvic bottom and III - a rupture of skin, muscles and a wall of a rectum.
Perineotomiya call a crotch section on the median line from back soldering of a vagina towards an anal opening. Epiziotomiya - the same section originating from back soldering, but at an angle about 45? With to the right or to the left (is more often to the right).the Section of a crotch can be carried out by
under local anesthesia Novocaine or Lidocaine , and can - without anesthesia, considering that there are numerous physiological mechanisms protecting a crotch from pain in labor. In surgical sense the section has numerous advantages before a rupture of a crotch: the section has smooth edges (and the hem, as a result, turns out more esthetic), the section is made on the necessary depth and rather seldom spontaneously lasts on nearby bodies.Ruptures of a crotch are taken in by
layer-by-layer: in the beginning a special number of seams takes in a rectum wall (if, of course, it is required). Then by means of the resolving sutural material ( catgut suture, vikrit, PGA ) muscles of a crotch and only then - skin connect. On skin seams from not resolving material - silk, kapron or a nikant are usually imposed (the kapron impregnated with an antibiotic Gentamycin or Tetratsikliny ). The same principle is observed also at restoration of integrity of a crotch after a perineotomiya or an epiziotomiya.
of the Technique of suture . If edges of a section rather equal, are an opportunity for imposing of a cosmetic intracutaneous seam. This seam came to surgery from cosmetology. The essence of a technique of its imposing consists that the thread passes in more thickly skin in zigzag fashion, coming to light only at the beginning and the end of a section. Thereof the hem turns out thinner and deprived of such specific accessory of a surgical seam as marks from having stuck and having pricked out the needles accompanying a “usual“ seam on both sides.
Apply also a technique at which one thread stitches both muscles, and skin at once. This technique allows to compare well fabrics, process of healing is least painful. Such seam is imposed the resolving material.
healing Period . Healing of a seam on a crotch is a little more problematic, than seams on a neck of a uterus and a vagina. Good healing of any wound requires several conditions, among which rest and an asepsis are important (that is the maximum protection against pathogenic microorganisms). Several decades ago after a gap or a section of a crotch of the patient several days observed a bed rest that very promoted good healing of a wound. Now in connection with universal distribution of joint stay of mothers and kids in postnatal chamber providing absolute rest of a crotch is problematic.by
complicated also providing the aseptic conditions necessary for healing. Continuous contact with postnatal allocations (lokhiya), and also lack of an opportunity to fix a sterile bandage on a wound is the factors creating some difficulties in treatment of wounds on a crotch.
to help the organism to overcome these difficulties, it is necessary to watch purity of the respective area first of all strictly. Each 2 hours it is necessary to change hygienic laying. In the conditions of a hospital processing of seams antiseptic solutions is usually carried out by personnel on a gynecologic chair or on a bed once a day. After each urination and a defekation it is necessary to make a podmyvaniye warm water or weak solution of manganese then to dry the blotting movements area of a seam a pure towel. Houses within 1,5 - 2 months after the delivery recommend to do it as in maternity hospital, and.to
in the presence of seams on a crotch needs a mechanical shchazheniye (rest) for muscles and skin of the respective area. In spite of the fact that full immobilization of the woman in childbirth, as a rule, happens impossible, movements have to be minimum and careful. The woman in childbirth with seams within 10 days after the delivery cannot sit down; non-compliance with this recommendation can lead to a divergence of seams. For convenience of young mothers postnatal offices are equipped with the “fourchette“ little tables for meal standing, it is possible to eat lying in a bed, also on a special bedstand. Within 2 - 3 days after the delivery it is not recommended to use bread and other products from flour and grain as much as possible to delay approach of a chair (though after an enema in patrimonial office of a chair and so there will be no day 2 or 3).Seams from not resolving material usually remove
on 6 - 7 - y day after their imposing. If the woman in childbirth is already discharged from maternity hospital, seams are removed in the conditions of a maternity welfare unit. It is simple and low-painful procedure. But also after it it is necessary to continue to follow rules of hygiene strictly. Only not earlier than in 10 days after the delivery the woman in labor can sit, and in the beginning on a rigid chair and only then - on soft sofas and chairs.by
By certain difficulties will accompanied a trip home from maternity hospital. To avoid troubles, it is necessary to adopt the provision reclining on a back seat of the car. Warn relatives that except young parents and the kid only one person because only the front seat will be free can go by the car.
Seams after Cesarean section
Cesarean section - extensive band operation when which performing the set of various soft fabrics which consistently connect seams is dissected.
the Seam on a uterus . Suture on a uterus - an important stage of operation of Cesarean section. Now Cesarean section is most extended in the lower segment of a uterus by a cross-section. Section length - 11 - 12 cm. Such section creates optimum conditions for healing of a wound on a uterus and minimizes operational blood loss, but if for any reasons this direction of a section is difficult, “classical“ or “korporalny“ Cesarean section with performance of a longitudinal section of a body of a uterus of the same length is made.to
For years of development of obstetric science stated great variety of opinions on what and as it is necessary to take in a uterus to create optimum conditions for incubation of the subsequent pregnancies. Now a uterus most often sew up with a single-row or two-row continuous seam with use of the resolving materials with the big period of full absorption (i.e. actually rassasyvaniye) - 70 - 120 days ( vikrit, monokrit, Dickson, kaproag ). Also imposing of special separate seams is sometimes applied. However any of these techniques at careful performance yields excellent results, and the preference in practice is, as a rule, given to that technique which is most fulfilled in concrete obstetrical establishment.
in domestic clinics even more often apply in recent years a uterus section by means of the American office of firm “by Auto Syyuche`s “ (“Auto Suture“). By means of this device the section on a uterus with simultaneous imposing on edges of a wound of brackets from the resolving material is made that allows to reduce blood loss size considerably.by
After an ushivaniye of a wound on a uterus and audit of abdominal organs consistently take in a bryushinny cover, muscles of a forward belly wall, a sinew and hypodermically - fatty cellulose. The resolving semi-synthetic threads or usual catgut suture are for this purpose applied.
Seams on skin . The choice of a method of an ushivaniye of a skin wound after Cesarean section depends on the direction of a section of skin. There are very many quick accesses at Cesarean section, but three types of skin cuts are most widespread in modern obstetrics:
- of of Nizhnesredinnaya laparotomy (section of a forward belly wall) .
the Section is carried out vertically, on the median line between a bosom and a navel, 12 - 15 cm long. Its main advantage - speed and convenience therefore this type of a skin section is almost always applied in emergency situations when several minutes can have crucial importance (for example, at massive bleeding).
- the Laparotomy according to Joel - to Kokhen (to Joel - Cohen) .
the Cross-section which is made 2 - 3 cm below by the middle of distance between a bosom and a navel. It is convenient and rather fast quick access at Cesarean section.
- the Laparotomy across Pfannenshtil .
the Cross-section of the arc-shaped form is made on the course of a skin nadlobkovy fold (fig. 36). This circumstance - the best cosmetic effect - causes a wide circulation of this type of intervention. Being in a skin fold, the thin skin hem merges with it and sometimes becomes in general hard to distinguish. Besides, both cross-sections create favorable conditions for imposing of an intracutaneous seam about which we spoke above. The longitudinal section is taken in always separate silk (or from other not resolving material) by seams because in this case seams are in conditions of bigger mechanical loading; respectively, more great demands are placed on the mechanical durability of a skin seam.
healing Period . The first one - two days after operation the area of a seam is rather painful and demands medicamentous anesthesia. Is a source of pain, of course, not only a skin wound - pain causes all soft fabrics crossed at operation. Despite it, the early rising is very useful (in a day after operation). Sometimes, especially at the developed hypodermic cellulose of a stomach, the relief is given by the carrying a postnatal bandage limiting mobility of soft tissues of stomach and by that providing more absolute rest to a skin wound.Seams on skin process
antiseptic solutions every other day or every day with imposing of a tight sterile bandage. The self-adhesive bandages which are on sale in drugstores are very convenient. If seams silk, remove them on 7 - e days, before an extract., as a rule, does not have
After an extract in independent care of skin seams need - enough all-hygienic actions. The seam can be washed with water with soap, abstaining only from the strong pressure upon it and application of rigid sponges and basts.
the Resolving materials have the different mechanism of a rassasyvaniye, they differently lose durability, resolve through different amount of time. It can cause features of the postnatal period.
So, threads of a natural origin resolve under the influence of the enzymes which are produced in a liver that is followed by the expressed reaction of surrounding fabrics - there can be a reddening, from places having stuck transparent separated leaks. As catgut suture is natural biological material, it can cause allergic reactions. This circumstance complicates healing, the divergence of seams is possible.
Synthetic threads ( vikrit, PDS ) resolve as a result of hydrolysis, i.e. are dissolved under the influence of organism liquids when water gets into thread fibers. In comparison with the mechanism of a resorption of natural threads hydrolysis causes less expressed reaction of an organism. Time of a rassasyvaniye of sutural material averages:
- of Catgut suture completely resolves within 30 days, but durability loses in 7 days, that is in the presence of ketgutovy seams on a crotch of “thread“ separate on 7 - y day. Vikril completely rezorbirut
- in 60 - 90 days. This material is widely used at Cesarean section.
- of PDS (makson) completely resolves to 210 - mu to day. PDS use for connection of sinews after operation of Cesarean section.
several words about psychological consequences of patrimonial traumatism and Cesarean section. It would seem, it is difficult to find the young woman absolutely indifferent to emergence of hems on the body. However any of the serious researchers dealing with psychological problems of women in childbirth does not call existence of a skin hem among the significant reasons for negative emotions in the postnatal period. For example, young mothers after Cesarean section are concerned much more that the spouse saw the child earlier, than it, than existence of some there skin hem. Let seams and hems will remain an insignificant episode in the history of your childbirth. And doctors and modern medical technologies will help you with it.