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A - MSRA Obstetrics [16] > [43] Perineal Tear > Flashcards

[43] Perineal Tear Flashcards

1
Q

What is a perineal tear?

A

A laceration of the skin and other soft tissues which separate the vagina from the anus in women

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2
Q

What is the most common cause of perineal tear?

A

Childbirth

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3
Q

How common is perineal tear as an obstetric injury?

A

The most common

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4
Q

What % of women who have a vaginal delivery will have some degree of perineal trauma?

A

85%

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5
Q

What is the rate of 3rd/4th degree perineal tear in primips having normal vaginalis delivery?

A

4%

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6
Q

What is the rate of 3rd/4th degree perineal tear in primips having instrumental delivery?

A

6.9%

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7
Q

What is the rate of 3rd/4th degree perineal tear in multips having spontaneous vaginal delivery?

A

1.5%

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8
Q

What is the rate of 3rd/4th degree perineal tear in multips having instrumental delivery?

A

2.5%

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9
Q

Why is vaginal delivery likely to cause perineal trauma?

A

The head of a term fetus is much larger than the birth canal

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10
Q

How does the fetal head cause perineal tear?

A

The soft tissues are stretched and compressed causing tearing

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11
Q

What are the risk factors for 3rd/4th degree perineal tear?

A
  • First baby
  • Large baby (>4kg)
  • Long second stage of labour
  • Shoulder dystocia
  • Operative vaginal delivery
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12
Q

What are the classifications of perineal tear?

A

1st - 4th degree

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13
Q

What is a 1st degree perineal tear?

A

Laceration is limited to fourchette and superficial perineal skin or vaginal mucosa

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14
Q

What is a second degree perineal tear?

A

Laceration extends to perineal muscles and fascia but not anal sphincter

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15
Q

What is a 3rd degree perineal tear?

A

Fourchette, perineal skin, vaginal mucosa, muscles and anal sphincter are torn

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16
Q

What can a third degree perineal tear be further subdivided into?

A
  • 3a
  • 3b
  • 3c
17
Q

What is a 3a perineal tear?

A

Partial tear of external anal sphincter involving <50% thickness

18
Q

What is a 3b perineal tear?

A

> 50% of external anal sphincter is torn

19
Q

What is 3c perineal tear?

A

Internal sphincter is torn

20
Q

What is a 4th degree perineal tear?

A

Rectal mucosa is torn

21
Q

What initial management should all perineal tears receive?

A

Adequate analgesia

22
Q

How can adequate analgesia be given for perineal tear?

A

Topping up epidural or infiltration with local anaesthetic

23
Q

How are 1st degree perineal tears usually managed?

A

Usually resolve quickly without treatment

24
Q

What treatment do 2nd degree perineal tears normally require?

A

Stitches

25
Q

What management do 3rd and 4th degree perineal tears require?

A

Repair in the operating theatre by an experienced obstetric surgeon

26
Q

How is the perineum repaired following a 3rd or 4th degree perineal tear?

A

Dissolvable stitches placed between the vagina and anus and underneath the skin

27
Q

What after care are patients given following a 3rd/4th degree perineal tear?

A
  • Antibiotics
  • Laxatives
  • Pain relief
28
Q

What wound care advice should women be given following perineal repair?

A
  • Keep area clean
  • If open, smelly, painful or bleeding seek medical attention
  • Normal to feel sore for 2-3 weeks
  • Urination can sting
  • Eat and drink plenty
  • Bowel control may not be as good for a few days
  • Can have sex when stitches have healed
29
Q

How can perineal tear be prevented?

A
  • Daily perineal massage from 35 weeks
  • Manual perineal protection
  • ‘Hands on techniques’
30
Q

What is annual perineal protection?

A

HCP supports the perineum as the baby is being born and may reduce risk of 3rd or 4th degree tears

31
Q

What is a ‘hands on technique’ in delivery?

A

Fetal head is guided through the vagina at a controlled rate

32
Q

What are the complications of a 1st/2nd degree perineal tear?

A

Rarely any

33
Q

What % of people who have a 3rd/4th degree perineal tear are asymptomatic after 12 months?

A

60-80%

34
Q

What are the potential complications of 3rd/4th degree perineal tear?

A
  • Faecal incontinence
  • Chronic perineal pain
  • Dyspareunia
  • Infection
  • May aggravate PND

A - MSRA Obstetrics [16] (61 decks)

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