Abstract
Objectives To establish anatomical structures responsible for a
resistance force on a fetal head during vaginal delivery; assess the
postpartum perception of perineal pain and superficial dyspareunia;
develop a new episiotomy. Design A prospective observational case series study.Setting International sites.Population Eighteen pregnant women in laborMethods Small V-shape excision was made on the
posterior-lateral vaginal outlet without incising the posterior perineum
or vaginal wall. Simple interrupted sutures were used to repair the
surgical defect (outlectorrhaphy). Histological examinations were
performed on excised specimens. Main Outcome Measures The primary maternal outcome measured postpartum
perineal pain; the secondary outcome measured occurrences of superficial
dyspareunia, results of Ostrzenski’s vaginal outlectomy, and APGAR
scores measured the neonatal outcome.Results The small V-shape excision widened the vaginal outlet
sufficiently for a vaginal delivery. Outlectorrhaphy required two-three
simple interrupted sutures. All subjects were delivered vaginally with
median newborns’ weight of 3,550 gm ±250gm and median APGAR scores of 9
±1 at 5 minutes. One patient experienced a grate II extension tear with
bleeding heavier than an uncomplicated vaginal outlectomy. Postpartum
patients reported no moderate or severe perineal pain and no superficial
dyspareunia. Histology showed that the vaginal outlet was deferred from
the vaginal walls.Conclusions The vaginal outlet is responsible for resistance
force on a fetal head. No moderate or severe perineal pain or
dyspareunia occurred in this study group. Ostrzenski’s vaginal
outlectomy widens the vaginal outlet sufficiently for a fetal vaginal
birth, and it is easy to repair.
Funding: The author did not receive any findings or grants for
the present study.
Keywords: Vaginal delivery; Episiotomy; Episiotomy tears;
Vaginal outlet; Ostrzenski’s vaginal outlectomy; Vaginal orifice.