1.

Primary wound closure: closure of recent wounds by approximation of the wound edges,
allowing for healing by primary intention

2. Secondary wound closure: leaving a wound to heal by secondary intention (i.e., without
approximating the wound edges)
3. Tertiary wound closure (delayed primary closure): surgical closure of a wound
after healing by secondary intention has already begun; also known as healing by tertiary
intention
4. Suture: is a thread like material used for stitching, lighting, or apposing tissue together
during operations until wound healing takes place.
Suture Class Tissue used Complete absorption
time
Plain catgut Absorbable Subcutaneous tissue , 7 days
suture Muscles, cord compression
Chromic catgut Absorbable Ligating peddles in hysterectomy, 21 days
suture muscles, fascia, EO aponeurosis.
Vicrly Synthetic Uterus, muscles, bowel 90 days
absorbable anastomosis
suture
Silk nature multifilament Non-absorbable Vascular anastomosis vessels, 7-10 before removal
nerves, tendons time.
Nylon synthetic Non-absorbable Skin, ractus sheeth 7-10 before removal
monofilament time.
Prolene synthetic Non-absorbable Hernioplast, posterior a.wall repair 7-10 before removal
monofilament time.
Primary suture: is when the wound edges are connected by a suture immediately after a
surgical incision.
Delayed primary suture: incision site left to close on its own by epithelialization and scar tissue
After which a surure is passed through for reinforcement.
Secondary suture: wound is left open and allowed to heal spontaneously.

 Good for contaminated/ infused wound.

 Increase scanting.
Surgical knot: is a knot used to bind suture materials together while binding tissue is surgery.
Names of four types of surgical knots:
 S: squer knot/ reef knot
S: surgeons knot
T: two handed knot
O: one handed knot
A: Aberdeen’s knot/ cobbler’s knot
G: granny’s knot/slip knot

Fetal lie

Is a relation of the fetal long axis to the long axis of the maternal uterus
 Types
o Longitudinal lie
o Transverse lie
o Oblique lie

Fetal presentation

 Is a part of the fetus that overlies the maternal pelvic inlet

 Types
o Cephalic presentation
o Breech presentation
o Compound presentation
o Shoulder presentation

Fetal position

 Definition: relationship and orientation (i.e., fetal occiput pointing towards maternal left or
right) of the presenting fetal part to the maternal pelvis
 Types
 Occiput anterior position:
o Left occiput anterior
o Right occiput anterior
 Occiput posterior position
 Fetal attitude

 Definition: degree of extension/flexion of the fetal head during cephalic presentation

 Types
o Vertex presentation
o Brow presentation
o Face presentation
o Forehead presentation

Station (Obstetrics): measurement (in cm) of the presenting part above and below the
maternal ischial spine

Station Description

0 the presenting part is at the level of the ischial spines

-1, -2, -3 1, 2, and 3 cm above the level of the ischial spines, respectively

+1, +2, +3 1, 2, and 3 cm below the level of the ischial spines, respectively

Engagement (Obstetrics)
 When the widest transverse diameter of the head (presenting part) passes through the pelvic
inlet

Synclitism: parallelism between the pelvic plane and the plane of the fetal head

In asynclitism: the sagittal suture is in the transverse diameter of the pelvic inlet and not between
the symphysis pubis and sacral promontory.

Normal mechanics of childbirth [1]

 Adaptation to the different forms of the pelvic region requires a great deal of rotation.

1. Engagement, descent, and increased flexion (occur simultaneously)

o The head engages below the plane of the pelvic inlet.
o The presenting part begins to descend into the birth canal.
o The chin of the fetus moves towards its chest.
2. Internal rotation: The fetal head rotates by 90° (two 45° steps) in the midpelvis, from a
transverse to anterior-posterior position.
3. Extension: The fetal head, lying behind the symphysis pubis bone and the pelvic floor, acts
upwards and forwards.
4. Restitution: The fetal head rotates 45° in the opposite direction as it passes through the pelvic
outlet.
5. External rotation: The anterior shoulder rotates 45° anteriorly as it meets the maternal pelvic
floor. This action is transmitted to the head which also rotates 45°, placing the head in its
original transverse position.
6. Expulsion: Delivery of the head, anterior shoulder followed by the posterior shoulder, and the
body

Perineal lacerations

tear of the perineal area due to significant or rapid stretching forces during labor and delivery

Postpartum endometritis
inflammation of the endometrium, possibly also including the myometrium and parametrium

Postpartum sexual dysfunction

the decline of sexual function after delivery that may not return to its baseline levels during the
postpartum period

Septic pelvic thrombophlebitis

a rare condition characterized by inflammation and thrombosis of the pelvic veins that most
commonly occurs in the postpartum period
Puerperal sepsis

maternal sepsis that develops in the timeframe between birth and 6 weeks postpartum

Postpartum urinary retention (PUR)

inability to void after delivery

Diastasis recti : a > 2 cm separation of the right and left rectus abdominis muscles resulting in
protrusion of abdominal organs on straining

Pubic symphysis diastasis

a rare complication of the peripartum period characterized by a widening of the pubic
symphysis beyond the physiological width (≤ 10 mm).