Perineal tears Flashcards
What causes perineal tearing
When the vaginal opening is too narrow to accomodate the babies head
What are some risk factors for perineal tearing
- First births (nulliparity)
- Large babies (over 4kg)
- Shoulder dystocia
- Asian ethnicity
- Occipito-posterior position
- Instrumental deliveries
1st degree perineal tear
injury limited to thefrenulum of the labia minora(where they meet posteriorly) and superficial skin
2nd degree perineal tear
including theperineal muscles, but not affecting the anal sphincter
3rd degree perineal tear
including theanal sphincter, but not affecting the rectal mucosa
4th degree perineal tear
including therectal mucosa
3A perineal tear
<50% external anal sphincter affected
3B perineal tear
> 50% external anal sphincter affected
3C perineal tear
External and internal anal sphincter affected
Management of stage 2 or worse perineal tears
Suturing or theatre repair
What are some additional measures taken in perineal tears
Broad-spectrum antibiotics
Laxatives
Physiotherapy
Follow-up
How will women who have a 3rd or 4th degree tear delivery next time?
They are offered an elective C-section
Short term complications of perineal tears
Pain
Infection
Bleeding
Wound dehiscence or breakdown
Long lasting complications of perineal tears
Urinary incontinence
Anal incontinence
Fistula
Sexual dysfunction
Dyspareunia
Psychological and mental health consequences
What is an episiotomy?
where the obstetrician or midwife cuts the perineum before the baby is delivered. This is done in anticipation of needing additional room for delivery of the baby (e.g. before forceps delivery). It is performed under local anaesthetic
How is an episiotomy performed?
Under local anaesthetic
A cut is made mediolaterally, from the opening of the vagina downwards at a 45 degree angle
What is perineal massage?
A method for reducing the risk of perineal tears. It involves massaging the skin and tissues between the vagina and anus (perineum). This is done in a structured way from 34 weeks onwards to stretch and prepare the tissues for delivery.
