Posterior vaginal repairs may address an enterocele, rectocele, and/or
perineal body defect.
Mariana's clinical pearl is that the delivering clinician should be seated, carefully observe the delivery of the shoulders, and facilitate fetal shrugging by gently reducing the bisacromial diameter as the posterior shoulder transitions over the
perineal body.
ASARP was introduced by Okada in 1992 for treatment of rectovestibular and anovestibular fistula (6,7) The advantages of ASARP over the previously mentioned techniques are: Separation of posterior vaginal wall from rectum which is considered the most important step of the operation, surgery under direct vision the rectum is placed and anchored within the muscle complex and the
perineal body is accurately reconstructed.
The
perineal body in goat is very thin, but it does demarcate the vagina and anal sphincter.
Not all
perineal body or anal sphincter defects are associated with anal incontinence.
A midline incision is made from the
perineal body to the vaginal apex.
Despite commonly expressed concerns, at twelve weeks they found no difference in pelvic floor function, incontinence or
perineal body measurements between the sutured and unsutured group.
TABLE 1 Classification of perineal injury (9) INJURY DEFINITION First degree Injury confined to vaginal mucosa Second degree Injury of vaginal mucosa and perineal muscles, but not the anal sphincter Third degree Injury to the perineum involving the anal sphincter complex (external and internal) 3a <50% of external sphincter thickness is torn 3b >50% of external sphincter thickness is torn 3c Internal sphincter is torn Fourth degree Injury to external and internal sphincter and rectal mucosa/anal epithelium TABLE 2 Major risk factors for obstetric anal sphincter injury RISK FACTOR ODDS RATIO Nulliparity (primigravidity) 3-4 Inherent predisposition: Short
perineal body 8 Instrumental delivery, overall 3 Forceps-assisted delivery 3-7 Vacuum-assisted delivery 3 Forceps vs vacuum 2.
Here, the
perineal body prevents communication between the right and left fossae.
Los ANGELES -- Third-and fourth-degree lacerations during delivery are more likely to happen in Asian American women and women with a shortened
perineal body, two separate studies concluded.
Surgical approaches to postobstetrical
perineal body defects (rectovaginal fistula and chronic third and fourth-degree lacerations).
Other landmarks used are genital hiatus (gh),
perineal body (pb), and total vaginal length (tvl).
