Episiotomy and Tears

Question 1

What are first degree perineal tears??

Management?

Answer 1

Superficial damage with no muscle involvement

Suture unless skin edges well opposed to aid healing

Question 2

What are second degree perineal tears?

Answer 2

Injury to the perineal muscle but not involving the anal sphincter

Question 3

What are third degree tears?

Answer 3

Injury to perineum involving anal sphincter complex (external anal sphincter (circular fibres) , internal anal sphincter (longitudinal fibres))

Question 4

What is a 3a tear?

Answer 4

Less than 50% of external anal sphincter thickness torn

Question 5

What is a 3b tear?

Answer 5

More than 50% of external anal sphincter thickness torn

Question 6

What is a 3c tear?

Answer 6

External and internal anal sphincters torn

Question 7

What is a fourth degree tear?

Answer 7

Injury to perineum involving anal sphincter complex and anal/rectal mucosa also involved
- repaired in theatre with epidural or GA

Question 8

What are risks factors for perineal tears?

Answer 8

Primagravida
Large babies
Precipitant labour
Shoulder dystocia
Forceps delivery

Question 9

What should you do after perineal repair?

Answer 9

Antibiotic prophylaxis with 3rd/4th degree tears
High fibre diet
Lactulose
Follow up in 6-12 weeks

Question 10

What is episiotomy?

Answer 10

Performed to enlarge the outlet e.g. to hasten birth of distressed baby, for instrumental or breech delivery, and to try to prevent 3rd degree tears

Question 11

Which tissues are cut in episiotomy?

Answer 11

Vaginal epithlium
Perineal skin
Bulbocavernous muscle
Superficial and deep transverse perineal muscles

Question 12

What are problems with episiotomy?

Answer 12

Bleeding
Infection
Breakdown
Haematoma formation

Question 13

What should you suggest post episiotomy?

Answer 13

Ice pack
Salt bath
Hair dryer to dry perineum
Rectal diclofenax