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Re: Episiotomy questionFrom: AllanHo@aol.comSun Feb 17 12:24:35 2008
In a message dated 2/17/2008 12:00:25 PM Eastern Standard Time, annam@uic.edu writes: Agree with John. I have been up to my elbow inside a woman with no episiotomy, going after a posterior arm. It works a LOT better if she is in the all-4's position. TONS more room posteriorly when the sacrum is mobile and not being sat on. Anna Meenan, MD
>I wear size eight gloves, I have never had any trouble running my hand I have to admit that I do not have Anna's or John's wealth of experience. However, according to an article I read, no one can be a true expert in handling shoulder dystocia because it is relatively uncommon. While I neither advocate nor condemn the practice of proctoepisiotomy, the only place I remember its mentioning is during the management of shoulder dystocia, including the ACOG Practice Bulletin #40, 2002 - "Controversy exists as to whether episiotomy is necessary, because shoulder dystocia typically is not caused by obstructing soft tissue. Direct fetal manipulation with either rotational maneuvers or delivery of the posterior arm also may be used (43). In these circumstances, performance of a proctoepisiotomy may be helpful to create more room within the posterior vagina." Allan
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