Perineal Tear Mangament

Question 1

Obstetric anal sphincter injury incidence

Answer 1

1% of all vaginal births

Question 2

Incidence of obstetric anal sphincter with mediolateral episiotomy is performed

Answer 2

0.6-0.9% of vaginal births with mediolateral episiotomy

Question 3

Technique of suturing and material of suturing of EAS

Answer 3

Overlapping or end to end
(Overlapping dec risk of fecal incontinence and urgency)

3-0 PDS OR VICRYL

Question 4

Technique and material of suturing of IAS

Answer 4

End to end repair with mattress or interrupted suture

Fine suture 3-0 PDS OR VICRYL 2-0

Question 5

Technique and material of suturing of anal mucosa

Answer 5

Continuous or interrupted

3-0 vicryl

Question 6

Most common complications of 3rd or 4th degree tears

Answer 6

Fecal incontinence
Urge incontinence
Dysparunia
Chronic perineal tear

Question 7

Recurrence of perineal tear

Answer 7

5-7%

Question 8

Incidence of obstetric anal sphincter tear in PG in UK

Answer 8

6.1%

Question 9

Incidence of obstetric anal sphincter tear in MP in UK

Answer 9

1.7%

Question 10

Percentage of women will be asymptomatic after 12 months of EAS repair

Answer 10

60-80%

Question 11

Structure divided during mediolateral

Answer 11

Transverse perineal muscles
Bulbocavernosus muscle
Part of levator ani
Transverse perineal branches of pudendal vessels and nerves

Question 12

Structure divided during midline episiotomy

Answer 12

Central perineal tendon

Question 13

If symptomatic at 12 months of repair, what will be symptoms

Answer 13

Fecal incontinence 59%
Fecal urgency 26%

Question 14

If symptomatic or have abnormal endanal us or manometry future deliveries

Answer 14

Elective CS

Question 15

Risk factors of perineal tears

Answer 15

Forceps delivery 7%
NP, prolonged 2nd stage >1 hr 4%
Midline episiotomy 3%
IOL, birth weight >4 kg, epidural 2%

Question 16

Advantage of mediolateral episiotomy in preventing perineal tears

Answer 16

Larger the angle lower the risk

Reduction 50% of the risk for each 6 degrees away from the midline

Question 17

Epsiotomy is i a tear of what degree

Answer 17

2nd degree

Question 18

A para vaginal hematoma is bounded superiorly by

Answer 18

Cardinal ligament

Question 19

With regard to vulval haematoma’s what structure limits its spread?

Answer 19

Anterior urogenital diaphragm