الفهرس 
ANATOMYOnly 14 pages are availabe for public view
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Abstract
Within the area bounded by the lower vagina, perineal skin, and anus is a mass of connective tissue called the perineal body. The term central tendon of the perineum has also applied to this structure and is descriptive, suggesting its role as a central point into which many muscles insert.
Although several maternal, fetal, and operator variables have been blamed for causing posterior perineal lacerations, very little is known about the relative interaction or confounding effect of the length of the perineum as a potential risk factor.
The functional importance of the length of the perineum has been largely neglected by clinicians, despite the fact that its important role in the diagnosis and classification of pelvic organ prolapse has recently been appreciated. A short perineal body was identified as being associated with weakness of the anatomical support of the pelvic viscera in their report, but without further discussion of the significance of the finding.
Episiotomy and posterior perineal lacerations are frequent obstetric events that may be associated with significant and debilitating postoperative morbidity.
In the last 20 years, reliable scientific observations have been made on several aspects of birth care. Evidence from randomized clinical trials showed that avoiding perineotomy protect perineal integrity.
This study aimed to define the normal perineal body length during labor and determine if a shortened perineal body is associated with perineal lacerations or operative vaginal delivery and to evaluate the effect of perineal stretching on perineal damage during vaginal delivery.
This study included 200 pregnant patients admitted for labor in Ain Shams University Maternity hospital during the period from May 2008 to October 2008. Full history was taken from the women, general, abdominal, and local pelvic examination were done.
Perineal measurements were taken in 3 different occasions for each parturient: in the beginning of the active phase of labor, during the second stage, with the vertex at the crowning position, and 24 hours after delivery, using a flexible measuring tape disinfected by betadine against the perineal tissue. landmarks used for perineal measurement included perineal body length, and genital hiatus length. Perineal stretching is calculated by change in perineal body length in percent of primary perineal length. Follow up of cases was done after 2, 6, 12 weeks, for the development of urinary and/or anal incontinence, dyspareunia, and perineal pain.