Perineal trauma Flashcards
When do perineal tears occur?
External vaginal opening too narrow to accomodate the baby
When are perineal tears more common? /risk factors
First births (nulliparity)
Large babies (>4kg)
Shoulder dystocia
Asian ethnicity
Occipito-posterior postiion
Instrumental deliveries
When are perineal tears more common? /risk factors
First births (nulliparity)
Large babies (>4kg)
Shoulder dystocia
Asian ethnicity
Occipito-posterior postiion
Instrumental deliveries
Degrees of perinneal tear
First to fourth
What is a first degree perinneal tear
Injury limited to frenulum of labia minora - where meet posteriorly and superficial skin
Second degree perineal tear
Incl perineal muscles but not anal sphincter
THird degree perineal tear
Incl anal sphincter but nnot affecting rectal mucosa
Fourth degree perineal tear
incl rectal mucosa
How are third degree tears subcategorised?
3A
3B
3C
What is 3A perineal tear?
3A - <50% of external anal sphincter affeted
3B vs 3C perineal tear
3B - >50% of external anal sphoncter affected
3C - extermal and internal anal sphincter affected
When are sutures required in perineal tears?
Anything over first degree tears
What tears need theatre reparing?
third and fourth degree
What additional measires are taken to reduce risk of complications of tears?
Broad spectrum antibiotics - reduce rusk of infections
Laxatives - constipation and wound dehiscience
Physiotherapy - reduce risk and severity incontinence
Follow up - monitor for longstanding complications
When are women offered C section after tears?
3rd or 4th degree tears that cause symptoms
Short term complications after repair of tears
Pain
Infection
Bleeding
Wound dehiscene or wound breakdonw
Lasting compliations of perineal tears?
Urinary incontinence
Anal incontinence and altered bowel habit (3rd and 4th degree)
Fistula between vagina and bowel
Sexual dysfunction and dyspareunia
Psychological and mental hekth consequences
What is an episiotomy
Cutting the perineum in preparation for need for wider delivery eg instrumental with local anaesthetic
How is an episiotomy done
Cut 45 degrees diagonally from opening vagina down and laterally
Avoid damaging anal sphincter
Mediolateral episiotomy
What is perineal massage and when is it done
Reducing risk of perineal tears
Massaging the skin and tissues between vagina and anus - perineum
Done in a structured way from 34 weeks to stretch and prepare tissues for delivery
