Perineal Tears Flashcards
Perineal Tears
When the external vaginal opening is too narrow to accommodate the baby.
Causes the skin and tissues to tear as the baby’s head passes
Third degree anal tear
Involves the anal sphincter
Fourth degree tear
Involves the rectal mucosa
Risk factor ps for perineal tears
First births (nulliparity)
Large babies (over 4kg)
Shoulder dystocia
Asian ethnicity
Occipito-posterior position
Instrumental deliveries
First degree perineal tear
Injury limited to the frenulum of the labia minora (where they meet posteriorly) and superficial skin
Secondary degree perineal tear
Including the perineal muscles, but not affecting the anal sphincter
Management of first degree perineal tears
Do not require any sutures
Management of a second degree perineal tear
Sutures
Management of a third degree or fourth degree perineal tear
Sutures in theatre
How to reduce the risk of complications from a perineal tear
Broad-spectrum antibiotics to reduce the risk of infection
Laxatives to reduce the risk of constipation and wound dehiscence
Physiotherapy to reduce the risk and severity of incontinence
Follow up to monitor for longstanding complications
Women that are symptomatic after third or fourth-degree tears
Offered an elective caesarean section in subsequent pregnancies
Short term compilations of perineal tears
Pain
Infection
Bleeding
Wound dehiscence or wound breakdown
Long term complications of perineal tears
Urinary incontinence
Anal incontinence and altered bowel habit (third and fourth-degree tears)
Fistula between the vagina and bowel (rare)
Sexual dysfunction and dyspareunia (painful sex)
Psychological and mental health consequences
How is an episiotomy done
Under local anaesthetic
Cut is made at around 45 degrees diagonally, from the opening of the vagina downwards and laterally - mediolateral episiotomy
Avoid damaging the anal sphincter
Purpose of a perineal Massage
Reduces the risk of a perineal tear
