Perineal Tears

Question 1

Define a 1st degree perineal tear.

Answer 1

Superficial damage with no muscle involvement

Question 2

Define a 2nd degree perineal tear.

Answer 2

Injury to the perineal muscle, but not involving the anal sphincter

Question 3

Define a 3rd degree perineal tear.

Answer 3

Injury to perineum involving the anal sphincter complex (EAS and IAS)

• 3a: <50% of EAS
• 3b: >50% of EAS
• 3c: IAS torn

Question 4

Define a 4th degree perineal tear.

Answer 4

Injury to perineum involving the anal sphincter complex (EAS and IAS) and rectal mucosa

Question 5

What is the management of perineal tears?

Answer 5

• Stitches - 3rd and 4th may require this to be done in theatre
• Antibiotics - 3rd and 4th
• Analgesia
• Laxatives
• Follow-up
  
  • 1st and 2nd degree tears = GP
  • 3rd and 4th = Gynaecology OP, physio
• Future pregnancies (for 3rd and 4th)
  
  • Do not need prophylactic episiotomy
  • Measure anorectal manometry pressure to see if ELCS should be offered in future pregnancies