Perineal Tears

Question 1

What is a first degree tear and how is it managed?

Answer 1

superficial damage with no muscle involvement

do not require any repair

Question 2

What is a second degree tear and how is it managed?

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

What is a third degree tear and how is it managed?

Answer 3

injury to perineum involving the anal sphincter complex

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 is a fourth degree tear and how is it managed?

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

What are RFs for perineal tears?

Answer 5

primigravida
large babies
precipitant labour
shoulder dystocia
forceps delivery