A novel obstetrical surgical intervention - New episiotomy: Case series study

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Fetal Delivery Mechanics

Background:

• The vaginal outlet's resistance to fetal head passage is a critical factor in vaginal delivery.
• Traditional episiotomy techniques can lead to significant postpartum pain and complications.

Purpose of the Study:

• To identify the anatomical structures creating resistance during fetal head descent.
• To develop and evaluate a novel episiotomy, termed vaginal outlectomy, for widening the vaginal outlet.

Main Methods:

• A prospective observational case series involving eighteen women undergoing vaginal delivery at term.
• A V-shape excision of the hymeneal membrane, ring, and plate was performed, avoiding posterior perineal structures.
• Vaginal outlectomy repair (outlectorrhaphy) and histological examination of excised tissues were conducted.

Main Results:

• The V-shape vaginal outlectomy successfully widened the vaginal outlet without requiring a perineal incision.
• Postpartum, patients reported no moderate to severe perineal pain, and no dyspareunia at 3 months.
• Histological analysis confirmed the absence of skeletal muscle in the excised hymeneal tissues, suggesting the posterior perineum offers minimal resistance.

Conclusions:

• The vaginal outlet, specifically the hymeneal structures, is the primary source of resistance during fetal head descent.
• Vaginal outlectomy is a safe and effective procedure for widening the vaginal outlet, minimizing postpartum pain and dyspareunia.