UNDERSTANDING EPISIOTOMY C-SECTION AND RECTOCELE. Our suture portfolio meets all your procedural needs

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1 UNDERSTANDING EPISIOTOMY C-SECTION AND RECTOCELE Our suture portfolio meets all your procedural needs

2 GYNECOLOGY Episiotomy A surgically planned incision on the perineum and the posterior vaginal wall, performed during the birthing process. It provides sufficient area for the delivery of the baby and minimizes or avoids lacerations of the perineum or rectum. Episiotomy is done as prophylaxis against soft-tissue trauma. Vaginal tears can occur during childbirth, most often at the vaginal opening as the baby s head passes through, especially if the baby descends quickly. Tears can involve the perineal skin or extend to the muscles of the anal sphincter and anus. Techniques Midline episiotomy Midline incision in the direction of the anus Midline episiotomies are incisions directed downward from the middle of the fourchet, including the vaginal mucosa and the underlying fascia and muscle Medio-lateral episiotomy (45 degree incision) Begins at the same point as the midline, but is directed laterally to avoid the rectum Advantage: rarely extends and damages the rectal mucosa Disadvantage: increase in blood loss and greater postpartum pain Has to be followed by an episiorrhaphy Obstetric laceration = perineal tear An unplanned tearing of the perineum, also called spontaneous obstetric laceration Classified as first, second, third, and fourth degree First-degree tear involves a tear of the vaginal mucosa but spares any underlying muscle and tissue Second-degree tear extends through the muscle and fascia Third-degree tear extends into the rectum Fourth-degree tear encompasses the entire thickness of the perineal body and into the rectal mucosa Episiorrhaphy Surgical repair (suturing) of a lacerated vulva or of an episiotomy Techniques Traditional method Suturing in different layers Vaginal wall Perineal muscles Skin One stitch, one knot All layers are sutured with one single suture by a continuous stitch Possible use of Fast sutures Closure of all layers in one size and needle to be discussed with the surgeon (1) External sphincter repaired (2) Posterior vaginal wall closed (3) Perineum closed (4) One-stitch knot Possible Use of s in Episiorrhaphy Mucosa Suturing Muscle Interrupted or Skin Subcuticular Brand Fast Size 0, 2-0, 3-0 Polysorb / 0, 2-0, Biosyn 3-0 Fast/ Caprosyn 3-0, 4-0 Tip Point/ cut Point/ cut P or C Reverse Cutting

3 C-Section Delivery of the fetus through an abdominal incision and hysterotomy A surgical incision through the abdominal wall and the uterus, performed to deliver a fetus Two classifications: classical or low cervical Classical refers to delivery of an infant through a vertical incision in the corpus of the uterus (greater blood loss/increased risk of uterine rupture with subsequent pregnancy) Low cervical refers to a transverse incision in the lower, noncontractile portion of the uterus Possible use of Fast sutures Dermal/subcuticular closure C or P needles Rectocele (perineal access) Relaxation of the muscles of the posterior vaginal wall, causing the rectum to protrude into the vagina Steps of rectocele repair Patient is in the lithotomy position. Transverse incision is made at the posterior fourchette. Dissection of the posterior mucosa off the perirectal fascia is done with Kelly clamps. Vertical incision in the posterial vaginal mucosa is made. Perirectal fascia is dissected. Rectum and rectocele appear. Rectocele is repaired, and rectal fascia is restored. Levator muscles are retightened. Subcutaneous and dermal closure can then be done. Possible use of Fast sutures Subcuticular and dermal closure Uterus - Polysorb continuous suture Fascia - Polysorb continuous suture Subcuticular - Fast continuous suture Skin - Topical Adhesive Possible Use of s in C-Section Brand Size Tip Uterine Muscle Polysorb / Caprosyn / Biosyn 0, 2-0 Point Fascia Polysorb / Maxon / Novafil 2-0, 3-0 Point Dermal Fast/ Biosyn / V-Loc 90 Device 3-0, 4-0 P or C Reverse Cutting

4 PROCEDURAL REVIEW Gynecology C-Section Rectocele TECHNICAL DATA Episiotomy or lacerations = episiorrhaphy Braided Synthetic Absorbable Registered Brand Name Fast Polysorb Composition 90% Glycolide / 10% Lactide 93% Polyglycolic Acid / 7% Polylactic Acid Coating Glycolide and Lactide Copolymer and Calcium Stearate Sterilization Gamma Irradiation Ethylene Oxide Glycolide, Caprolactone and Calcium Stearoyl Lactylate Construction Multifilament (braid) Multifilament (braid) Coated Yes Yes Colors Violet or Undyed Violet or Undyed USP Sizes Tensile Strength 7 10 Days 3 Weeks Mass Absorption Days Days Monofilament Synthetic Absorbable Registered Brand Name Caprosyn Biosyn Maxon Composition 60% Glycolide 20% Caprolactone 10% TMC 10% Lactide 60% Glycolide 14% Dioxanone 26% TMC 67% Glycolide 33% TMC Coating None None None Sterilization Ethylene Oxide Ethylene Oxide Ethylene Oxide Construction Monofilament Monofilament Monofilament Colors Violet, Undyed Violet, Undyed Green, Clear USP Sizes 6-0 to to to 1 Tensile Strength 10 Days 3 Weeks 6 Weeks Mass Absorption 56 Days 90 and 110 Days 180 Days

5 The techniques described herein and the use of instructions for the related procedures are made available by Medtronic to the healthcare professional to illustrate the user s suggested procedure. In the final analysis the preferred procedure is that which in the healthcare professional s judgment addresses the need of the individual patient. IMPORTANT: Please refer to the package insert for complete instructions, contraindications, warnings and precautions. Photo credit istock Medtronic. All rights reserved. Medtronic, Medtronic logo and Further, Together are trademarks of Medtronic. All other brands are trademarks of a Medtronic company. 16-emea-velosorb-procedural-brochure To contact us, please visit medtronic.com/covidien/support/emea -customer -service Use scan app to read