Perineal Tears

Question 1

6 risk factors for a perineal tear

Answer 1

1) Large baby (>4kg)
2) First delivery
3) Shoulder dystocia
4) Asian ethnicity
5) Instrumental deliveries
6) Occipito-posterior position

Question 2

1st degree tears

Answer 2

involve only the frenulum of the labia minora

Question 3

2nd degree tears

Answer 3

involve the perineal muscles but not the anal sphincter

Question 4

3rd degree tears

Answer 4

involve the anal sphincter

Question 5

4th degree tears

Answer 5

involve the anal mucosa

Question 6

perineal tears:

3A
3B
3C

Answer 6

<50% of the external sphincter
>50% of the external sphincter
involving the internal sphincter as well

Question 7

management of:

first degree tears

second degree tears

third degree tears and above

Answer 7

unlikely to need sutures

will require sutures

likely to require repair in theatre

Question 8

Why is it important to give laxatives after a perineal tear?

Answer 8

Constipation can lead to straining and wound dehiscence

Question 9

How can the risk and severity of incontinence be reduced following a perineal tear?

Answer 9

Physiotherapy can help with both of these

Question 10

severity of perineal tear which is an indication for caesarean in following pregnancies

Answer 10

3rd or 4th degree tear + symptoms

Question 11

5 long term sequelae to perineal tears

Answer 11

1) Urinary incontinence
2) ) Faecal incontinence and altered bowel habit
3) Painful sex
4) Rectal-vaginal fistula (rare)
5) Psychological effects

Question 12

acute method of avoiding perineal tears

Answer 12

episiotomy

Question 13

longer term method of avoided perineal tears

Answer 13

perineal massage from 34 weeks onwards (to stretch the perineal muscles in time for delivery)