perineal tears Flashcards
perineal tears are most common with
first baby large baby >4kg shoulder dystocia asian ethnicity occipito-posteior position instrumental delivery
1st degree
limited to frenulum of labia minora and superficial skin
2nd degree
incl perineal muscles but not affecting anal sphincter
3rd degree
inc anal sphincter
not affecting rectal mucosa
4th degree
incl rectal mucosa
3rd degree - A
< 50% external anal sphincter
3rd degree - B
> 50% external anal sphincter
3rd degree - C
external and internal anal sphincter
Mx - first degree
no not usually require sutures
Mx - larger than 1st degree
sutures required
Mx - 3rd or 4th
likely to need repaired in theatre
additional measures
broad-spec antib
laxatives
physio
follow up
woman symptomatic after 3rd or 4th degree tear are offered
elective CS in subsequent pregnancies
short term complications
pain
infection
bleeding
wound dehiscence/breakdown
lasting complications
urinary incontincen
anal incont, alt bowel habit
sexual dysfunciton
dyspareunia