Predicting OASIS and tears in individual women is inaccurate and midwifery practices can do little to prevent them.
§ Elective / low thresh-hold for LSCS in patients with the following risk factor/s:
•
Nulliparity
•
Macrosomia of more than 4kg
•
Gestational
diabetes mellitus (GDM)
•
Prolonged
1st stage of labour (7-to-10 interval >3hours)
•
Prolonged
active 2nd stage of labour >60 mins)
•
No/poor
descent during instrumental delivery
•
High head
(not visible on parting vagina, PA & VE)
§ Encourage epidural analgesia
§ Perineal protection at crowning
can be protective, control delivery of the head may prevent burst injuries. (Grade C) PINCHING TECHNIQUE
§ Left hand slowing down the
delivery of the head, the head is flexed and the right hand protecting the
perineum (Pinching Technique as in Finish Intervention Trial).
§ Clinicians should explain to
women that the evidence for the protective effect of episiotomy is conflicting.
( Grade C)
§ If an episiotomy is warranted
than, a medio-lateral episiotomy (60 degree angulation) has been shown to reduce
OASIS.
§ Early
extension of episiotomy should be performed to avoid further damage
§ Forcible
delivery should be avoided, it should be
replaced with vacuum delivery
by use the Kiwi cup for OT & OP positions
§ Delivery
the head should be in between contraction. The mother should not push vigorously when head is
crowning (communicate).
§ Do take care during the delivery of the shoulder, continue to protect the perineum (midwife/assistant) during delivery of the head & shoulders
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