Laserasi Perineum Dan Vagina
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LASERASI PERINEUM DAN VAGINA
MUNIZAR NB
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Pendahuluan
Laserasi perineum dibagi menurut kedalaman
Sekuele ⇨ Inkontinensia Episiotomi dan forsep ⇩ → Laserasi
perineum ⇩ Teknik bedah :
Overlapping End to end
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Anatomi Perineum
Dibentuk oleh ototM. BulbokavernosusM. Perineum transversalM. PuborektalisM. Sfingter ani eksternus
Sfingter ani internus terletak diatas S.a.e
S.a.i → kontribusi tonus anus
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Gambar perineum
A. MUSKULUS PERINEALIS B. SFINGTER ANI
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Klasifikasi Laserasi
Tingkatan laserasi: Tingkat I mengenai mukosa vagina dan
jaringan ikat. Tingkat II mengenai mengenai kulit dan
membrane mukosa, fasia dan otot-otot perineum.
Tingkat III mengenai muskulus sfingter ani.
Tingkat IV mengenai mukosa rectum
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Prinsip pembedahan
Lighting dan visualisasi >>InstrumenAnalgesikAnestesiaAntibiotik
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Repair Laserasi Perineum
Tingkat I : No terapi needed Tingkat II :
Identifikasi puncak vagina Jahit di puncak vagina 1 Cm
diatasnya Jahitan jelujur Approksimasi otot perineum Repair sesuai anatomi
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Gambar
Laserasi perineum derajat II
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Laserasi perineum derajat dua dengan gambaran otot dibawahnya
Mukosa vagina dan fascia rektovagina
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Laserasi derajat dua
Repair of transverse perineal muscles with single interrupted suture
Repair of bulbocavernosus muscle with single interrupted suture.
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Repair laserasiderajat tiga-empat
Approksimasi mukosa rektum, sfingter ani internus dan sfingter ani internus
Tidak boleh menembus seluruh ketebalan mukosa → fistula
S.a.i → Jaringan fibrous putih berkilat antara mukosa rektum dan S.a.e
S.a.e → pita otot rangka dengan kapsul fibrous
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Laserasi tgkt 3 - 4
Reattachment of rectovaginal septum to muscles of perineal body.
Fourth-degree perineal laceration
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Laserasi derajat tiga-empat
Repair of rectal mucosa. Internal anal sphincter and external anal sphincter.
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Perawatan postpartum
Informasi dalam literatur <<Nyeri → periksa adanya infeksi.Laksansia → mengurangi
dehisensi
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Pencegahan
Minimalkan episiotomi dan persalinan operatif
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TERIMA KASIH