text:
Episiotomy
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Episiotomy
Medio-lateral episiotomy as baby crowns.
Pronunciation
/əˌpiːziˈɒtəmi, ˌɛpəsaɪˈ-/
ICD-9-CM
73.6
MeSH
D004841
MedlinePlus
002920
[edit on Wikidata]
Episiotomy, also known as perineotomy, is a surgical incision of the perineum and the posterior vaginal wall generally done by a midwife or obstetrician. Episiotomy is usually performed during second stage of labor to quickly enlarge the opening for the baby to pass through. The incision, which can be done at a 90 degree angle from the vulva towards the anus or at an angle from the posterior end of the vulva (medio-lateral episiotomy), is performed under local anesthetic (pudendal anesthesia), and is sutured after delivery.
Its routine use is no longer recommended.[1] Despite this, it is one of the most common medical procedures performed on women. In the United States, as of 2012, it was performed in 12% of vaginal births.[1] It is still widely practiced in many parts of the world, including Japan, Taiwan, China, and Spain.[2][3]
Contents
[hide]
1 Uses
2 Types
3 Controversy
3.1 Discussion
3.2 Impacts on sexual intercourse
4 Pain management
5 See also
6 References
7 External links
Uses[edit]
Vaginal tears can occur during childbirth, most often at the vaginal opening as the baby's head passes through, especially if the baby descends quickly. Episiotomy is done in an effort to prevent against soft-tissue tearing which may involve the anal sphincter and rectum. Tears can involve the perineal skin or extend to the muscles and the anal sphincter and anus. The midwife or obstetrician may decide to make a surgical cut to the perineum with scissors or a scalpel to make the baby's birth easier and prevent severe tears that can be difficult to repair. The cut is repaired with stitches (sutures). Some childbirth facilities have a policy of routine episiotomy.[4]
Specific reasons to do an episiotomy are unclear.[1] Though indications on the need for episiotomy vary and may even be controversial (see discussion below), where the technique is applied, there are two main variations. Both are depicted in the above image.
In one variation, the midline episiotomy, the line of incision is central over the anus. This technique bifurcates the perineal body, which is essential for the integrity of the pelvic floor. Precipitous birth can also sever—and more severely sever—the perineal body, leading to long-term complications such as incontinence. Therefore, the oblique technique is often applied (also pictured above).
In the oblique technique, the perineal body is avoided, cutting only the vagina epithelium, skin, and muscles (transversalius and bulbospongiosus). This technique aids in avoiding trauma to the perineal body by either surgical or traumatic means.
In 2009, a Cochrane meta-analysis based on studies with over 5,000 women concluded that: "Restrictive episiotomy policies appear to have a number of benefits compared to policies based on routine episiotomy. There is less posterior perineal trauma, less suturing and fewer complications, no difference for most pain measures and severe vaginal or perineal trauma, but there was an increased risk of anterior perineal trauma with restrictive episiotomy".[4] The authors were unable to find quality studies that compared mediolateral versus midline episiotomy.[4]
Types[edit]
Illustration of midline and medio-lateral incision sites for possible episiotomy.
Illustration of infant crowning and midline and medio-lateral incision sites for possible episiotomy during delivery.
There are four main types of episiotomy:[5]
Medio-lateral: The incision is made downward and outward from the midpoint of the fourchette either to the right or left. It is directed diagonally in a straight line which runs about 2.5 cm (1 in) away from the anus (midpoint between the anus and the ischial tuberosity).
Median: The incision commences from the centre of the fourchette and extends on the posterior side along the midline for 2.5 cm (1 in).
Lateral: The incision starts from about 1 cm (0.4 in) away from the centre of the fourchette and extends laterally. Drawbacks include the chance of injury to the Bartholin's duct, therefore some practitioners have strongly discouraged lateral incisions.
J-shaped: The incision begins in the centre of the fourchette and is directed posteriorly along the midline for about 1.5 centimetres (0.59 in) and then directed downwards and outwards along the 5 or 7 o'clock position to avoid the internal and external anal sphincter. This procedure is also not widely practised.
Controversy[edit]
Traditionally, physicians have used episiotomies in an effort to deflect the cut in the perineal skin away from the anal sphincter muscle, as control over stool (faeces) is an important function of the anal sphincter, i.e. lessen perineal trauma, minimize postpartum pelvic floor dysfunction, and as muscles have a good blood supply, by avoiding damaging the anal sphincter muscle, reduce the loss of blood during delivery, and protect against neonatal trauma. While episiotomy is employed to obviate issues such as post-partum pain, incontinence, and sexual dysfunction, some studies suggest that episiotomy surgery itself can actually cause all of these problems.[6] Research has shown that natural tears typically are less severe (although this is perhaps not surprising since an episiotomy is designed for when natural tearing will cause significant risks or trauma). Slow delivery of the head in between contractions will result in the least perineal damage.[7] Studies in 2010 based on interviews with postpartum women have concluded that limiting perineal trauma during birth is conducive to continued sexual function after birth. At least one study has recommended that routine episiotomy be abandoned for this reason.[8]
In various countries, routine episiotomy has been accepted medical practice for many years. Since about the 1960s, routine episiotomies have been rapidly losing popularity among obstetricians and midwives in almost all countries in Europe, Australia, Canada, and the United States. A nationwide U.S. population study suggested that 31% of women having babies in U.S. hospitals received episiotomies in 1997, compared with 56% in 1979.[9] In Latin America it remains popular, and is performed in 90% of hospital births.[10]
Discussion[edit]
Having an episiotomy may increase perineal pain during postpartum recovery, resulting in trouble defecating, particularly in midline episiotomies.[11] In addition, it may complicate sexual intercourse by making it painful and replacing erectile tissues in the vulva with scar tissue.[12]
In cases where an episiotomy is indicated, a mediolateral incision may be preferable to a median (midline) incision, as the latter is associated with a higher risk of injury to the anal sphincter and the rectum.[13] Damage to the anal sphincter caused by episiotomy can result in faecal incontinence (loss of control over defecation). Conversely, one of the reasons episiotomy is performed is to prevent tearing of the anal sphincter, which is also associated with faecal incontinence. Damage to the anal sphincters is more common, especially during prolonged or difficult childbirth, or where forceps are used, that has been traditionally acknowledged. Whether episiotomy reduces, or indeed increases, the chances of faecal incontinence is difficult to say. A sacral nerve stimulator implant, which works like a heart pacemaker, can provide impulses to the pelvic floor muscles which tighten up the pelvic floor, improving control over the large bowel and compensating for faecal incontinence.
Impacts on sexual intercourse[edit]
Some midwives compare routine episiotomy to female circumcision.[14] One study found that women who underwent episiotomy reported more painful intercourse and insufficient lubrication 12–18 months after birth but did not find any problems with orgasm or arousal.[15]
Over-zealous repair, using a so-called "husband stitch" to increase vaginal tightness can exacerbate pain during intercourse.[16][17]
Pain management[edit]
Perineal pain after episiotomy has immediate and long-term negative effects for women and their babies. These effects can interfere with breastfeeding and the care of the infant.[18] The pain from injection sites and episiotomy is managed by the frequent assessment of the report of pain from the mother. Pain can come from possible lacerations, incisions, uterine contractions and sore nipples. Appropriate medications are usually administered.[19] Routine episiotomies have not been found to reduce the level of pain after the birth.[20]
See also[edit]
Perineal massage
References[edit]
^ Jump up to: a b c "Practice Bulletin No. 165: Prevention and Management of Obstetric Lacerations at Vaginal Delivery". Obstetrics and gynecology. 128 (1): e1–e15. July 2016. doi:10.1097/AOG.0000000000001523. PMID 27333357.
Jump up ^ Chang,S-R; Chen,K-H; Lin,H-H; Chao,Y-M Y.; Lai,Y-H (April 2011). "Comparison of the effects of episiotomy and no episiotomy on pain, urinary incontinence, and sexual function 3 months postpartum: A prospective follow-up study". International Journal of Nursing Studies. 48 (4): 409–418. doi:10.1016/j.ijnurstu.2010.07.017. PMID 20800840.
Jump up ^ Graham,I.D.; Carroli,G.; Davies,C.; Medves,J.M. (August 2005). "Episiotomy Rates Around the World: An Update". Birth. 32 (3): 219–223. doi:10.1111/j.0730-7659.2005.00373.x.
^ Jump up to: a b c Carroli, G, Mignini, L. "Episiotomy for vaginal birth". Cochrane Database Syst Rev. 2009 Jan 21; (1): CD000081.
Jump up ^ D. C. Dutta, Textbook of Obstetrics, 7th edition, 2011.
Jump up ^ Thacker, S. B.; Banta, H. D. (1983). "Benefits and risks of episiotomy: An interpretative review of the English language literature, 1860-1980". Obstet Gynecol Surv. 38 (6): 322–38. doi:10.1097/00006254-198306000-00003. PMID 6346168.
Jump up ^ Albers L. L.; et al. (2006). "Factors Related to Genital Tract Trauma in Normal Spontaneous Vaginal Births". Birth. 33 (2): 94–100. doi:10.1111/j.0730-7659.2006.00085.x. PMID 16732773.
Jump up ^ Rathfisch, G. et al. "Effects of perineal trauma on postpartum sexual function." Journal of Advanced Nursing. 2010 Aug 23.
Jump up ^ Weber, A. M.; Meyn, L. (2002). "Episiotomy use in the United States, 1979-1997". Obstetrics & Gynecology. 100 (6): 1177–82. doi:10.1016/S0029-7844(02)02449-3. PMID 12468160. Retrieved 2012-01-16.
Jump up ^ Althabe, F.; Belizán, J. M.; Bergel, E. (2002). "Episiotomy rates in primiparous women in Latin America: hospital-based descriptive study". BMJ. 324 (7343): 945–6. doi:10.1136/bmj.324.7343.945. PMC 102327  . PMID 11964339.
Jump up ^ Signorello, L. B.; Harlow, B. L.; Chekos, A. K.; Repke, J. T. (2000). "Midline episiotomy and anal incontinence: retrospective cohort study". BMJ. 320 (7227): 86–90. doi:10.1136/bmj.320.7227.86. PMC 27253  . PMID 10625261.
Jump up ^ "Total Health For Women Painful Intercourse". mothernature.com.
Jump up ^ American College of Obstetricians-Gynecologists (2006). "ACOG Practice Bulletin. Episiotomy. Clinical Management Guidelines for Obstetrician-Gynecologists. Number 71, April 2006" (PDF). Obstetrics & Gynecology. 107 (4): 956–62. doi:10.1097/00006250-200604000-00049. Retrieved 2012-01-16. Abstract.
Jump up ^ Joan Cameron; Karen Rawlings-Anderson (1 March 2001). "Female circumcision and episiotomy: both mutilation?". British Journal of Midwifery. 9 (3): 137–142. doi:10.12968/bjom.2001.9.3.7997. Retrieved 2012-01-16.
Jump up ^ Hanna Ejegård; Elsa Lena Ryding; Berit Sjögren (17 January 2008). "Sexuality after Delivery with Episiotomy: A Long-Term Follow-Up". Gynecologic and Obstetric Investigation. 66 (1): 1–7. doi:10.1159/000113464. PMID 18204265. Retrieved 2012-01-16.
Jump up ^ "The Husband Stitch". www.mamabirth.com. 28 July 2013. Retrieved 15 October 2017.
Jump up ^ Vinopal, Lauren (17 August 2017). "Are Husbands and Doctors Conspiring to Sew New Moms Up Too Tight?". Fatherly. Retrieved 15 October 2017.
Jump up ^ Molakatalla, Sujana; Shepherd, Emily; Grivell, Rosalie M; Molakatalla, Sujana (2017). "Aspirin (single dose) for perineal pain in the early postpartum period". Cochrane Database Syst Rev. 2: CD012129. doi:10.1002/14651858.CD012129.pub2. PMID 28181214.
Jump up ^ Henry, p. 122.
Jump up ^ Jiang, Hong; Qian, Xu; Carroli, Guillermo; Garner, Paul; Jiang, Hong (2017). "Selective versus routine use of episiotomy for vaginal birth". Cochrane Database of Systematic Reviews. doi:10.1002/14651858.CD000081.pub3.
External links[edit]
Episiotomy, Merck Manual Professional Edition
Stages of Labor, Merck Manual Professional Edition
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At sixes and sevens
From Wikipedia, the free encyclopedia
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For the album by Sirenia, see At Sixes and Sevens.
"At sixes and sevens" is an English idiom used to describe a condition of confusion or disarray.
Contents
[hide]
1 Origin and early history
2 Similar phrases
3 References
4 External links
Origin and early history[edit]
An ancient dispute between the Merchant Taylors and Skinners livery companies is the probable origin of the phrase.[1] The two trade associations, both founded in the same year (1327[2]), argued over sixth place in the order of precedence. In 1484, after more than a century and a half of bickering, the Lord Mayor of London Sir Robert Billesden ruled that at the feast of Corpus Christi, the companies would swap between sixth and seventh place and feast in each other's halls. Nowadays, they alternate in precedence on an annual basis.[1][2]
A similar phrase, "to set the world on six and seven", is used by Geoffrey Chaucer in his Troilus and Criseyde. It dates from the mid-1380s and seems from its context to mean "to hazard the world" or "to risk one's life".[3] William Shakespeare uses a similar phrase in Richard II, "But time will not permit: all is uneven, And every thing is left at six and seven".
The phrase is also used in Gilbert & Sullivan's comic opera H.M.S. Pinafore (1878), where Captain Corcoran, the ship's Commander, is confused as to what choices to make in his life, and exclaims in the opening song of Act II, "Fair moon, to thee I sing, bright regent of the heavens, say, why is everything either at sixes or at sevens?"
The phrase took on additional meaning during the early 1960s, when debate over Britain's position in Europe under Harold Macmillan centred on membership of the EEC 'Six' or the EFTA 'Seven' smaller independent states.
The phrase appears in a few songs, including "Don't Cry for Me Argentina" from the musical Evita, "Raoul and the Kings of Spain" from Tears for Fears, and "Playing With Fire" by Stereo MCs. The eleventh studio album from Strange Music front man Tech N9ne was entitled "All 6's and 7's". The song "Sixes and Sevens" was co written and sung by Robert Plant. It also appears in the Rolling Stones' song "Tumbling Dice". There is an album by Norwegian gothic metal band Sirenia called At Sixes and Sevens(including a song with the same name) where this phrase is used in several songs.
The phrase is also used in the 1978 movie The Wiz, when Miss One gives Dorothy the silver slippers and comments, "Oh, don't be all sixes and sevens, honey" to Dorothy as Dorothy is in a state of confusion after killing the Wicked Witch of the East. It is also found in the 1993 film The Remains of the Day. It is also mentioned in the 2002 film Goldmember by Mike Myers' character Austin Powers to his dad, who at the time were speaking "English English": "oh, the one who was all sixes and sevens?" During the second episode of season five of the HBO series Six Feet Under, George uses the phrase to describe his wife's attitude towards him.
We also come across the phrase in Sabina's opening monologue from Thornton Wilder's 1942 Pulitzer Prize winning play The Skin of Our Teeth: "The whole world's at sixes and sevens, and why the house hasn't fallen down about our ears long ago is a miracle to me."
Similar phrases[edit]
The phrase bears comparison with the Chinese phrase luan qi ba zao (乱七八糟/亂七八糟, literally "chaos seven eight rotten"), which means messy (which could refer to a messy situation—implying problems, which in turn could possibly include hazard, but hazard is not a necessary element to the Chinese phrase. The phrase could also be literally used to mean a physical mess) but instead uses the numbers seven and eight.[4]
Also, it can be compared with the Chilean phrase al tres y al cuatro, with a similar meaning, but using the numbers three and four.
In Arabic, the phrase يضرب أخماساً لأسداس (He shows fifths for sixths) is said of a devious person who says one thing but means another, (تاج العروس), which would naturally lead to a state of confusion and of being "at sixes and sevens".
A similar expression is used also in Persian where they say شش پنج ("He says five but he means six").
In the related Maltese language, the phrase sitta u sitta, tnax (six and six make twelve) exists, which is an ironic phrase used to describe someone who is aloof and has no idea what is going on.
In Russian, the phrase "семь, восемь" (literally, "seven (or) eight") means[citation needed] that something isn't done very well or precisely, so it measures "either seven or eight".
References[edit]
^ Jump up to: a b "World Wide Words: At sixes and sevens".
^ Jump up to: a b "The Livery Companies". theskinnerscompany.org.uk. 4 September 2014.
Jump up ^ "Troilus and Criseyde - Book 4, Lines 621-623". 12 June 2008. Archived from the original on 2008-06-12. CS1 maint: BOT: original-url status unknown (link)
Jump up ^ "Google Translate".
External links[edit]
Theories as to the origin of the phrase
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Invoice processing
From Wikipedia, the free encyclopedia
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Invoice processing involves the handling of incoming invoices from arrival to post. Invoices have many variations and types. In general, invoices are grouped into two types: 1. Invoices associated with a request or purchase order 2. Invoices that do not have an associated request (no purchase order).
Most organizations have clear instructions regarding processing incoming invoices. Different sets of instructions are commonly found in most organizations regarding the handling of purchase order invoices or non-purchase order invoices. The main department that processes invoices is known as accounts payable department. The process involving a supplier invoice is also known as purchase-to-pay.
Contents
[hide]
1 Typical Process
2 Automatic Process
3 Automation Software
4 References
Typical Process[edit]
A typical process involving paying a supplier invoice begins at the arrival of invoice at the door of the organization regardless of the methods of arrival such as via email, postal mail, facsimile, etc. Once the invoice arrives, the accounts payable clerk must ensure that the document is indeed an invoice. Then the clerk classifies and sorts the invoice into various categories. The definition of various categories is not always the same across different organizations but is normally defined by each organization.
Once its category defined, the invoice is forwarded to the responsible person for that particular invoice. This is normally the person who has placed that order. If there has been a purchase order involved when placing that order, the invoice must then be matched against the purchase order to ensure that the amount invoiced is correctly stated on the invoice. If the amount is right and the goods have arrived, the responsible person will have to approve the invoice by signing off on it. If the amount invoiced exceeds a certain amount that is limited by the organization, the superior of that person may have to approve the invoice as well. This, of course, differs from organization to organization.
Once the invoice has been approved and there have been no variances, the invoice is posted into the accounting system.[1][2][3][4]
A manual invoice process can sometimes exceed 15 steps before the final posting is done.
Automatic Process[edit]
Technology has long enabled the automation of invoice processing from arrival to post. This means that at arrival of the invoice, the same accounts payable clerk will only need to scan the invoice into an automation software. The automation software then converts the invoice's scanned image into a text researchable document. The different fields on an invoice can also be defined into the software so that it remembers which fields it should capture and register into the ERP systems, for instance, the amount purchase, the quantity, the supplier name, the supplier code, and so on. The benefits of an automatic processing work flow may include reduced human error, on-demand reports, and data resilience. Most automation software today integrates into common organizational ERP systems such as those offered by Dajon Data Management SAP, and Microsoft.
In an automatic process, once the data is extracted or captured from the invoice the data is sent into the system for automatic matching against the purchase order. This matching process can compare just the invoice data with that shown on the purchase order or be expanded to include a deeper level that looks at the receiving documents.[5] Workflow steps can be configured such that the responsible person will then receive an email alert so that he or she can approve the invoice. If there are other people involved in the approval work flow, email alerts to them will also be automatically generated.[6] The typical workflow is a four step process beginning with 1. Import of the images through scanning or email, 2. Identification of the vendor and business unit associated with the invoice, 3. Data extraction, and 4. Export of the extracted data and images.[7]
Automation Software[edit]
Pay Stream Advisors, an industry analyst, has defined accounts payable automation as the solutions and services which automate the people and paper-based processing invoices for approval and posting into the accounting system.[8] According to the Document Imaging Report, issue no. 8-17-07, there are around 3757 invoice processing applications in the world.[9]
In the 2008 report, "Optical Character Recognition: Invoice Imaging and Data Capture for Accounts Payable," Pay Stream advisors writes:
Intelligent Data Capture (IDC) or learning systems enable end users to extract content from invoices without the system having to learn the layout of the invoice. Some intelligent engines are able to correctly sort batches on the fly, locate data fields such as invoice and PO number, as well as line item information, and then extract the desired content from those data fields. Intelligent solutions do not require the coding of rules or design form templates. Rather the system learns by reviewing a relatively small number of invoice samples. This helps the system scale to large invoice volumes and widely varying document layouts without requiring a human operator to specify a template for each one, or explicitly create and tune an extensive library of keywords.[10]
Invoice processing automation software has emerged as what one consulting company has called a "disruptive innovation" whereby this new technological innovation has created a demand for a whole line of software products that previously did not exist. An example given was GPS tracking software for caregivers who were dealing with relatives suffering with dementia.[11] Invoice processing software as a disruptive innovation has produced tremendous labor savings to the extent that many companies have begun to consider it as a commodity much like word processing software.[12]
References[edit]
Jump up ^ "Business Process: Vendor Payment Process - PO Invoices". 11 March 2009. Archived from the original on 11 March 2009. Retrieved 6 September 2016.
Jump up ^ [dead link]http://www.obfs.uillinois.edu/obfshome.cfm?level=2&path=payments&xmldata=processinvoices
Jump up ^ "Invoice Processing Procedure (Accounts Payable)". 11 February 2012. Archived from the original on 11 February 2012. Retrieved 6 September 2016.
Jump up ^ "Fingate - iProcurement: How to Upload an Invoice". Retrieved 6 September 2016.
Jump up ^ "Two Way Match of AP Invoice and Purchase Order- UFCINC.COM". Retrieved 6 September 2016.
Jump up ^ "Import von Rechnungen (CSV)". rechnungsverwalter.de.
Jump up ^ "OCR Invoice Processing Software".
Jump up ^ "Outsource invoice processing".
Jump up ^ "Document Imaging Report - DOCUMENT IMAGING TALK". Retrieved 6 September 2016.
Jump up ^ Optical Character Recognition: Invoice Imaging and Data Capture for Accounts Payable
Jump up ^ Hill, Jim. "Disruptive Innovation Part 1: Software Impacting Daily Lives | User Friendly Consulting, Inc Blog | Company". UFC, Inc. Document Scanning and Forms Processing Software. Retrieved 2017-04-18.
Jump up ^ Hill, Jim. "Disruptive Innovation Part 2: Invoice Processing Software | User Friendly Consulting, Inc Blog | Company". UFC, Inc. Document Scanning and Forms Processing Software. Retrieved 2017-04-18.
Retrieved from "https://en.wikipedia.org/w/index.php?title=Invoice_processing&oldid=843612962"
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