perineal tears

Question 1

what is a first degree tear

Answer 1

First degree tear
Tear limited to the superficial perineal skin or vaginal mucosa only

Question 2

what is a second degree tear

Answer 2

Tear extends to perineal muscles and fascia, but the anal sphincter is intact (episiotomy is anatomically classified as second degree)

Question 3

what is a third degree tear

Answer 3

Third degree tear
3a: less than 50% of the thickness of the external anal sphincter is torn
3b: more than 50% of the thickness of the external anal sphincter is torn, but the internal anal sphincter is intact
3c: external and internal anal sphincters are torn, but anal mucosa is intact

Question 4

what is a fourth degree tear

Answer 4

Perineal skin, muscle, anal sphincter and anal mucosa are torn

Question 5

what is the management of perineal tears

Answer 5

First degree tears with minimal blood loss may not require suturing as they are superficial with no muscle involvement and are likely to heal quickly.

Second degree tears will require suturing as they involve perineal muscle. This may be carried out by an experienced midwife.

Third and fourth degree tears require surgical repair by an experienced clinician and should take place in an operating theatre under regional or general anaesthetic.

Broad-spectrum antibiotics and laxatives should be given post-operatively.

Although some bleeding is expected with a tear, any excessive bleeding from the genital tract should prompt further investigation.

Question 6

what pharmacological treatment should be given post operatively for perineal tear

Answer 6

ABx and laxatives

Question 7

types of twins

Answer 7

Dichorionic and diamniotic (two different sacs)
Monochorionic and diamniotic (same outer sac, two inner sacs)
Monochorionic and monoamniotic (same sacs) - most suceptble to twisting and twin transfusing sydnrome )

Question 8

You are taking an obstetric history for a newly pregnant patient attending her pre-booking appointment. She tells you she has had the following pregnancies:

2014: Miscarriage at 14 weeks gestation. 2015: Stillbirth male at 28 weeks gestation. 2017: Elective caesarean section of two twin males at 36+0 weeks gestation. 2019: Elective caesarean section live female at 39+2 weeks gestation. 2019: Medical termination at approximately 7 weeks gestation.

How would you describe this patients gravidity and parity?

Answer 8

G6 P3+2

gravida number of pregs ( 2014,2015,2017,2019,2019,2022

parity births gestational aeg at least 24 week, giving birth to a multiple pregnancy is counted as one
parity is suffxied by number of miscarriages or stillbriths before 24 week (2015(still) 2017(twin) and 2019(c section) - 3 birth 4 kids though
then also had stillbirth in 2015 and the termiantion in 2019 under 24 weeks so +2

Question 9

A 38 year old mother presents to the day assessment unit complaining of a headache. She has also noticed that her vision has been a bit blurry. She is 35 weeks pregnant and this is her second child. The first pregnancy was uncomplicated. Her blood pressure is measured and is found to be 155/105mmHg. A second blood pressure taken 4 hours later is 158/106 mmHg. On examination, she is apyrexial and heart rate is 85 bpm. She has some mild swelling in her legs and also displays hyper-reflexia. Urinalysis shows proteinuria. The mother reports normal fetal movements.

Which other investigations are important to carry out in this lady?

Answer 9

FBC and lvier fucntion
screen for HELLP