Intrapartum Care - Perineal Tears Flashcards
What is a Perineal Tear?
External vaginal opening is too narrow to accommodate the baby, leading to skin and tissues in that area tearing as the baby’s head passes.
Risk Factors of Perineal Tears (6).
- Nulliparity.
- Large Babies.
- Shoulder Dystocia.
- Asian Ethnicity.
- Occipito-Posterior Position.
- Instrumental Delivery.
Classification of Perineal Tears (4).
- 1st Degree - Limited to Frenulum of Labia Minor and Superficial Skin.
- 2nd Degree - Including Perineal Muscles.
- 3rd Degree - Including Anal Sphincter.
- 4th Degree - Including Rectal Mucosa.
Classification of 3rd Degree Tears (3).
A - Less than 50% of External Anal Sphincter is affected.
B - More than 50% is affected.
C - Both External and Internal Sphincters are affected.
Management of Perineal Tears.
- 1st Degree - No Sutures.
- 2+ Degree - Sutures correct injury.
- 3/4 Degree - Repair in Theatre.
Management of Perineal Tear Complications.
- Broad Spectrum Antibiotics - Infection Risk.
- Laxatives - Constipation and Wound Dehiscence Risk.
- Physiotherapy - Incontinence Risk.
- Follow-Up - Longstanding Complications.
- Future Elective C-Section - 3rd/4th Degree Symptomatic Tear.
Short-Term Complications of Perineal Tears (4).
- Pain.
- Infection.
- Bleeding.
- Wound Dehiscence/Breakdown.
Long-Term Complications of Perineal Tears (4).
- Urinary Incontinence.
- Anal Incontinence/Altered Bowel Habit.
- Enterovaginal Fistulae (Rare).
- Sexual Dysfunction/Dyspareunia.
What is an Episiotomy?
Cutting of the perineum before delivery in anticipation of needing additional room.
How is an Episiotomy done?
Mediolateral Episiotomy : Under Local Anaesthesia, cut at around 45 Degrees Diagonally from vaginal opening downwards and laterally to avoid damaging the anal sphincter. Suture after delivery.
What is a Perineal Massage?
Reduce risk of perineal tears using massaging skin and tissues in the perineum in a structured way from week 34 onwards to stretch and prepare tissues for delivery.
