I. PERINEUM (Figure 17-1)
A. General features. The perineum is the part of the pelvic outlet that is located inferior to the pelvic diaphragm. It is diamond-shaped and can be divided by a line passing through the ischial tuberosities into the anal triangle, which contains the anal canal, and the urogenital triangle, which contains the outlets of the urinary and genital organs.
B. Clinical consideration. Episiotomy is an incision made in the perineum to enlarge the vaginal opening during childbirth.
1. A median episiotomy starts at the frenulum of the labia minora and proceeds directly downward, cutting through the skin, vaginal wall, perineal body, and superficial transverse perineal muscle. The external anal sphincter muscle may be cut inadvertently.
2. A mediolateral episiotomy starts at the frenulum of the labia minora and proceeds at a 45° angle through the skin, vaginal wall, and bulbospongiosus muscle. This type creates more room than a median episiotomy.
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