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[″ + rhaphe, a sewing]
Suture of the perineum to repair a laceration that occurs or is made surgically during the delivery of the fetus.
Caregivers should implement standard precautions, wearing disposable gloves throughout perineal assessment, patient care, and disposal of biohazardous wastes, and performing thorough hand hygiene before and after procedures. Assessments focus on diet and fluid intake, bowel elimination, and the status of the suture line. To minimize potential for autoinfection, patient care and teaching should emphasize cleansing the perineum from front to rear after urination or defecation with a cascade of warm fluid or an antiseptic towelette. Perineal pads also should be applied and removed from front to rear. Application of an ice pack immediately after delivery and intermittently during the first 24 hr postpartum aids in reducing edema and relieving discomfort. To maximize effects, the ice pack should be removed 20 min after its placement and reapplied 10 min later and the mother taught this 20 min on, 10 min off regimen. The use of warm Sitz baths for 20 min several times daily is encouraged. Personal portable Sitz baths avoid the possibility of cross-contamination and may be sent home with the mother. Pain is assessed and analgesics are administered as prescribed. Ambulation also is encouraged. Gluteal splinting, i.e., tensing the buttocks while sitting or rising from a seated position, reduces discomfort. Health care professionals should provide support and reassurance because the patient may experience anxiety about the ability to resume normal physical functions and sexual activity and should provide opportunities for the patient to express feelings and to ask questions.