Perineal Trauma

Question 1

how would we classify a first degree tear?

Answer 1

injury to perineal skin and/or vaginal muscosa

Question 2

how would we classify a second degree tear?

Answer 2

injury to perineal muscles

transverse perineal muscle and sometimes bulbocavemosus

Question 3

how would we classify a third degree tear?

Answer 3

injury to perineum involving the anal sphincter complex

can be classified into 3a, 3b and 3c

Question 4

how would we classify a fourth degree tear?

Answer 4

injury to perineum involving anal sphincter (external and internal) and anorectal mucosa

Question 5

a third degree tear can be further classified into…

Answer 5

3a: less than 50% of external AS torn
3b: more than 50% of external AS torn
3c: both internal and external anal sphincter torn

Question 6

midwives heal up to what level of degree of tears?

Answer 6

first and second degree (including episiotomy)

Question 7

other types of perineal trauma that aren’t classified tears may include…

Answer 7

vaginal wall tear
labial graze
anterior tears that may extend to urethra or clitoris

Question 8

what are some risk factors that may increase the chances of perineal trauma?

Answer 8

asian ethnicity
instrumental birth
primiparity
fetal birth weight over 4kg
shoulder dystocia
prolonged second stage
malposition
age tissue type
nutritional state

Question 9

what are some ways perineal trauma may be prevented?

Answer 9

warm compresses in second stage
spontaneous pushing
slow crowning
upright position
routine episiotomy not recommended

Question 10

in the UK, ? of vaginal births result in perineal trauma

Answer 10

85%

3% resulting in 3rd or 4th degree tears

Question 11

what percentage of women with a previous OASI will have a reoccurrence in a subsequent birth?

Answer 11

5-7%

Question 12

what is the position performed in the UK during an episiotomy?

Answer 12

‘right mediolateral episiotomy’

at 60 degrees

Question 13

episiotomy rates for spontaneous vaginal births 1990 vs 2017:

Answer 13

1990: 21%
2017: 8.5%

Question 14

what are some reasons for an episiotomy being performed?

Answer 14

fetal HR anomalies
maternal wellbeing
'rigid' perineum
anticipation of significant perineal or rectal trauma ('buttonholing')
FGM
breech birth
shoulder dystocia

Question 15

factors that promote best practice for suturing:

Answer 15

good lighting
explanation and fully informed consent
should be completed within the hour of birth
woman should be cleaned and draped
local anaesthetic (up to 20mls of 1% lidocaine)
apex identified
documentation
postnatal advice given (washing, signs of infection etc)