Re: Suturing second degree lacerations
From: fran wilson (530rose@msn.com)
Wed Dec 21 12:59:14 2005
I can never get these to stay together. I stitch what I think is carefully, up one side and down the other with 4-0 Vicryl, and next time I see them it is all healed up with a little "notch" in the labia. So what am I doing wrong? The notch is usually very small 1/4 to 1/2 cm, but noticible by the patient. Bigger splits seem to heal a little better.
Fran Wilson CNM
From: <igold@cox.net>
Reply-To: ob-gyn-l@obgyn.net
To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
Subject: Re: Re: Suturing second degree lacerations
Date: Wed, 21 Dec 2005 11:34:09 -0600
I have always insisted that these be repaired. Moms are more cooperative if I tell them there is no choice, and it may interfere with sexual function if the "tag" is dragged in with intercourse. That said, I have seen a couple unrepaired over the years. They don't reapproximate spontaneously.Ingrid
>
> From: annam@uic.edu (Anna Meenan, MD)
> Date: 2005/12/21 Wed AM 08:27:55 EST
> To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> Subject: Re: Suturing second degree lacerations
>
> Well those you sorta have to repair, but the ones that tear
>
longitudinally down the side of the labia I leave alone unless active
> bleeding, and I give it a good while to see if it will stop (i.e. I
> don't suture while waiting for placenta).
>
> Anna Meenan, MD
>
> At Wed, 21 Dec 2005, Elrod Darryl G MAJ 48 MDOS/SGOBO wrote:
> >
> >What do you do then for deliveries that split the labia? I had two in a
> >row last week and I even had tried to sit on my hands during the
> >delivery! Both of them tore right through the labia. I feared that if
> >I didn't at least reapproximate them, she would be left with two
> >separate parts of her labia and not be pleased.
> >
> >Glen
> >
> >-----Original Message-----
> >From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Anna
> >Meenan, MD
>
>Sent: Wednesday, December 21, 2005 3:41 AM
> >To: Multiple recipients of list OB-GYN-L
> >Subject: Re: Suturing second degree lacerations
> >
> >I used to suture everything. Then my most difficult patient (bipolar
> >with extreme needle-phobia) refused to have her 2nd degree repaired.
> >The
> >nurses made her sign a refusal and I went over all the possible risks,
> >but it healed beautifully. Couldn't even see the scar line 6 weeks
> >later (as opposed to some women where I can see the line from their epis
> >years later). Have never again left a second-degree unrepaired, but
> >have left many 1st degrees unrepaired since then, and have always
> >silently thanked my difficult patient for showing me the healing powers
> >of the female perineal body.
>
>
> >Also, having personally experienced both sutures in the perineum and
> >sutures in the labia minora on various occasions, I would avoid putting
> >sutures anywhere near the labia at all costs.
> >
> >Anna Meenan, MD
> >
> >At Tue, 20 Dec 2005, GA12L@aol.com wrote:
> >>
> >>Thanks for that Ingrid. It backs up the research that suggests that
> >>unsutured tears heal just as well with less pain. And the fact that
> >sutures pull
> >>once healing starts. I remember it so well, the pain was awful and I
> >had to
> >>have them removed before they dissolved because I couldn't sit down.
> >Bathing
> >>helped but only for an hour or 2.
> >>
> >>I have left 2nd degree tears that are not bleeding after
discusing it
> >with
> >>the woman but if she wants to be sutured then I'll suture.
> >>
> >>Gail
>
>
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