BLOOD SUPPLY

By pudendal arteries branches of the internal iliac arteries.

VENOUS DRAINAGE: Corresponding veins of pudendal veins and branches of the internal iliac veins.

NERVE SUPPLY: From the perineal branch of the pudendal nerve.

LYMPHATIC DRAINAGE: This is into the inguinal and external iliac glands.

FUNCTIONS

• Support the pelvic and abdominal organs
• Assist in the process of defecating and child birth
• Assist in sneezing, coughing and laughing
• Forms a diaphragm which fills the outlet

INJURIES TO THE PELVIC FLOOR

The pelvic floor may be injured in 2 ways:

• • Tearing or laceration
  • Over stretching

During the last weeks of pregnancy this pelvic floor softens in preparation for laboring, during the 1st stage the woman bears down the tissues and cervical ligaments will become strained. The uterus may move downwards and after delivery becomes inverted or prolapsed.

2nd stage of labor If there is prolonged 2nd stage the muscles around the vagina and bladder becomes over stretched. This will cause cystocele or rectocele.

PERINEAL TEARS TEARS: The perineal muscles may become badly torn and this may also include levatores ani muscles. There are 3 types of tears known as:

1. 1st Degree tear: Involved the fourchette and skin this may need to 2 stitches.
2. 2nd Degree tear: This is where the tear is deep and large and has torn the skin and the muscles.
3. 3rd Degree tear: Is when the whole length of the perineum is torn through the skin and muscles and sphincter, the patient will be, therefore with incontinence of faeces through anus. This must always be repaired by the doctor and by the midwife.

PREVENTION OF INJURIES TO PELVIC FLOOR DURING ANC

• Encourage all pregnant mothers to attend ANC.
• Good ANC where good selection of mothers is carried out.
• Correct malpresentation early.
• Advice about balanced diet so as to get a health skin which cannot be torn easily.
• Health Education, mothers what to do during antenatal period.
• Advice about exercise.
• Anemia should be corrected if not corrected mother will have body weakness with weak muscle which can tear easily during labor.
• Discourage native medicine.

DURING LABOUR

• Recognize any malpresentation and get doctor to see her.
• Ensure an empty bladder throughout labor.
• Gain the mother’s confidence by instructing what to do during first stage.
• Give analgesic if accessing or severe pain.
• Midwife rubs the mothers back and relieves pain.
• Prevent anemia.

DURING SECOND STAGE

• Deliveries to be conducted by skilled midwife who can prevent tears occurring.
• Give a timely episiotomy after infiltrating it with local anesthesia 5 mls into the perineum.
• Mother is advised to push where there is a contraction. To pant when it passes off. After crowning of the head the mother is advised not to push but to pant.
• Proper guarding of the perineum. Fetal head to allow a small diameter to distend the perineum.