perineal tears

Question 1

perineal tears are most common with

Answer 1

first baby 
large baby >4kg
shoulder dystocia 
asian ethnicity
occipito-posteior position 
instrumental delivery

Question 2

1st degree

Answer 2

limited to frenulum of labia minora and superficial skin

Question 3

2nd degree

Answer 3

incl perineal muscles but not affecting anal sphincter

Question 4

3rd degree

Answer 4

inc anal sphincter

not affecting rectal mucosa

Question 5

4th degree

Answer 5

incl rectal mucosa

Question 6

3rd degree - A

Answer 6

< 50% external anal sphincter

Question 7

3rd degree - B

Answer 7

> 50% external anal sphincter

Question 8

3rd degree - C

Answer 8

external and internal anal sphincter

Question 9

Mx - first degree

Answer 9

no not usually require sutures

Question 10

Mx - larger than 1st degree

Answer 10

sutures required

Question 11

Mx - 3rd or 4th

Answer 11

likely to need repaired in theatre

Question 12

additional measures

Answer 12

broad-spec antib
laxatives
physio
follow up

Question 13

woman symptomatic after 3rd or 4th degree tear are offered

Answer 13

elective CS in subsequent pregnancies

Question 14

short term complications

Answer 14

pain
infection
bleeding
wound dehiscence/breakdown

Question 15

lasting complications

Answer 15

urinary incontincen
anal incont, alt bowel habit
sexual dysfunciton
dyspareunia

Question 16

episiotomy

Answer 16

cut to perineum before baby delivered

45 deg downward and laterlaly to avoid anal sphincter damage –> mediolateral episiotimy

Question 17

perineal massage

Answer 17

method for reduing risk of perineal tears

massage skin and tissues between vagina and anus
done from 34wks onwards to stretch and prepare tissues for delivery