Obstetrics

Question 1

Mangement of Perineal tears

1. First degree?
2. Second degree?
3. Third degree?
4. Fourth degree?

Answer 1

1. Superficial damage, repair not required
2. injury to perineal muscle, needs suturing - midwife
3. injury to perineum + anal spinchter complexs (External and internal) - 3a is <50% eas, 3b is >50% eas, 3c IAS torn - repair by surgeon
4. perineum + sphincter complex and rectal mucosa

Risk factors for perineal tears:
-primigravida
-large babies
-precipitant labour
-shoulder dystocia
-forceps delivery