Care of the perineum

Question 1

What is the perineum?

Answer 1

Part of the pelvic floor- made up of the perineal muscle and body

Question 2

What percent of women sustained perineal trauma?

Answer 2

85% (2005)

Question 3

What is a first degree?

Answer 3

skin and/or vaginal mucosa

Question 4

What is a second degree?

Answer 4

injury to the perineum involving perineal muscle

Question 5

What is a third?

Answer 5

injury to the perineum involving the anal sphincter

Question 6

What is a 3A?

Answer 6

3A:<50% of the external anal sphincter
3B: >50%external anal sphincter
3C: both EAS and internal anal sphincter

Question 7

What is a 4th degree?

Answer 7

injury to the perineum including EAS IAS and anorcetal mucosa

Question 8

What does OASIS stand for

Answer 8

Obstetric Anal Sphincter Injurys

Question 9

Risk Factors for perineal trauma?

Answer 9

Asian ethnicity 
Prev 3/4th 
Prolonged 2nd stage 
Instrumental 
Shoulders 
BWT >4kg
OP

Question 10

Prevention think PEACHES?

Answer 10

Postion
Extra midwife 
Assess at all time
Communication 
Hands on
Episiotomy 
Slowly 

Warm compress 2nd stage
Perineal massage

Question 11

When should episiotomy be considered?

Answer 11

instrumental
imminent 3/4th degree tear
fetal destress

Question 12

How to assess for a tear?

Answer 12

analgesia
structures involved 
apex of injury 
PR exam 
bleeding

Question 13

Postnatal care…

Answer 13

prophylaxtic abx
laxitives 
analgesia 
perineal hygiene
pelvic floor
examine PN check
follow up 6-8weeks - if any pain or incontinence ref gynaecologist 
fully inform woman

Question 14

Effects of tear?

Answer 14

poor birth experience 
PND
infection 
sex
incontinence

Question 15

prognosis for women?

Answer 15

60-80% asymptomatic at 12months