Perineal Tear

Question 1

Perineal tear

Answer 1

A perineal tear is a laceration of the skin and other soft tissue structures which, in women, separate the vagina from the anus.

Question 2

Injury to the birth canal

Answer 2

1. Vulva
2. Perineal
3. Vaginal
4. Cervical
5. Uterus

Question 3

Vulva : common site?

Answer 3

Vulval skin Posteriorly
Paraurethral tear on the inner aspect of the labia minora

Question 4

Mgt of vulva tear

Answer 4

Repair with interrupted cat gut sutur, after introducing of a rubber catheter in to the bladder to prevent urethral injury

Question 5

2. Perineal: due to?

Answer 5

Mismanaged 2nd SoL

Question 6

Results from?

Answer 6

1. Over stretching
2. Rapid stretching especially in inelastic perineum like in early primigravida or in perineal scar

Question 7

Classification of observation anal sphincter injury

Answer 7

●First degree: Injury to perineal skin only.
●Second degree: Injury to perineum involving
perineal body (muscles) but not involving the anal
sphincter.
●Third degree: Injury to perineum, involving the anal sphincter complex
3a: <50% of the EAS
3b: >50% of the EAS
3c: both external and internal anal sphincter
●Fourth degree: Injury to perineum involving the anal
sphincter complex (EAS and IAS) and anal
epithelium.
(EAS = External anal sphincter; IAS = Internal anal sphincter)

Question 8

Risk factors for 3rd degree perineal tear

Answer 8

• Big baby (weight ≥ 3 kg)
• Nulliparity
• Face to pubis delivery
• Outlet contraction with narrow pubic arch
• Shoulder dystocia
• Midline episiotomy
• Forceps delivery
• Precipitate labor
• Scar in the perineum (Perineorrhaphy, episiotomy)