Perineal tears

Question 1

what are 1st degree perineal tears?

Answer 1

superficial damage with no muscle involvemen
t
do not require any repair

Question 2

what re 2nd degree perineal tears?

Answer 2

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

require suturing on the ward by a suitably experienced midwife or clinician

Question 3

3rd degree perineal tears

Answer 3

injury to perineum involving the anal sphincter complex (external anal sphincter, EAS and internal anal sphincter, IAS)

3a: less than 50% of EAS thickness torn
3b: more than 50% of EAS thickness torn
3c: IAS torn

require repair in theatre by a suitably trained clinician

Question 4

what are 4th degree perineal tear

Answer 4

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

require repair in theatre by a suitably trained clinician

Question 5

risk factors

Answer 5

primigravida
large babies
precipitant labour
shoulder dystocia
forceps delivery