PERINEAL RUPTURE AND EPISIOTOMY. MEDICAL AND SOCIAL ASPECTS

Aim. After analyzing the frequency of perineal ruptures and dissections, select the most appropriate tactics and approach in the management of such patients. Materials and Methods. A retrospective analysis of the frequency of perineal rupture and its dissection for the period from 2007 to 2017 was conducted at the Ryazan State Clinical Hospital №10 and Ryazan State Clinical Maternity Hospital №1. Also, an analysis of the histories of childbirth of women giving birth through the birth canal was carried out in the Ryazan State Clinical Maternity Hospital №1, for 10 months in 2018. Results. The frequency of perineal dissection ranged from 12.6% in 2008 to 20.7% in 2018. In the period 2007-2014, an increase in the frequency of perineal rupture from 10.3 to 18.7%, with a consequent decrease in this type of injury to 12.7% in 2018. Episiotomy was performed in 25% of women in labor under the age of 18 years, 23.3% and 15% in the age groups 18-29 years and older than 30 years, respectively. The frequency of perineal rupture before the age of 18 years and older than 30 years was approximately the same and amounted to 10% and 11.1%. Perineal trauma was found much more often in women from 18 to 29 years old - 13.5%. As a result of the analysis, it can be seen that the smallest risk of perineal rupture among students, women in labor before the age of 18 and with a mass of newborns less than 3000 g. But despite this, the incidence of episiotomy in these women is quite high (32.2, 25 and 14.9%, respectively) and exceeds the frequency of perineal dissections in other groups, sometimes more than twice. Conclusion. The correct provision of obstetric help for childbirth in cephalic presentation, a more thorough assessment of the condition of perineal tissues, the refuse of routine shortening and rational management of the second stage of labor will reduce the frequency of episiotomy and rupture of the perineum.