3rd and 4th degree tears GTG

Question 1

Classification tear

Answer 1

1Perineal skin and/or vaginal mucosa
2 Perineal muscles, no sphincter
3a <50% EAS
3b >50% EAS
3c IAS
4 EAS + IAS + anorectal mucosa

Question 2

Overall risk of 3/4th tear

Answer 2

2.9%

Question 3

P0 risk of 3/4th tear

Answer 3

6%

Question 4

Multip risk of 3/4th tear

Answer 4

1.7%

Question 5

Forceps without episiotomy

Answer 5

23%

Question 6

Forceps with episiotomy

Answer 6

6%

Question 7

Ventouse no episiotomy

Answer 7

6%

Question 8

Ventouse with episiotomy

Answer 8

2%

Question 9

Previous OASIS

Answer 9

7% (25% have CS)

Question 10

What suture material should be use for anorectal mucosa?

Answer 10

3-0 polyglactin

Question 11

What suture material should be used for EAS/IAS

Answer 11

3-0 PDS
or 2-0 polyglactin

Question 12

What is the risk of suture migration?

Answer 12

7%, bury sture

Question 13

What % of women are asymptomatic at 12 months following EAS repair?

Answer 13

60-80%

Question 14

Who should be offered ELCS?

Answer 14

Symptomatic or abnormal endoanal USS

Question 15

If previous 3/4th what % experience worsening of faecal symptoms?

Answer 15

17% worsening faecal Sx, especially if beyond 3 months

Question 16

Risk of incontience of stools/flatus

Answer 16

Common 1/10-1/100

Question 17

Risk faecal urgency?

Answer 17

26/100

Question 18

Risk perineal pain/dyspareunia?

Answer 18

9/100

Question 19

Risk wound infection

Answer 19

8/100