Perineal Trauma

Question 1

What % of women have perineal trauma? (state source)

Answer 1

85% (Albers et al. 2005)

Question 2

What is the perineum?

Answer 2

Part of the pelvic floor made up of the perineal muscle and perineal body

Question 3

What is a 1st degree tear

Answer 3

superficial skin tear

Question 4

What is a 2nd degree tear

Answer 4

tear to perineal muscle and skin

Question 5

What is a 3rd degree tear?

Answer 5

Tear to the anal sphincter

Question 6

What is a 4th degree tear?

Answer 6

Tear to the anal sphincter and mucosa

Question 7

Describe AN care for perineal tears

Answer 7

Inform women of risks
Perineal massage (Beckman and Stock, 2013)

Question 8

What increases the risk of perineal tears?

Answer 8

instrumental delivery
shoulder dystocia
= >4kg
primiparous 
long second stage 
previous 4th degree tear

Question 9

What can consequences of 3rd and 4th degree tears be?

Answer 9

Urinary and faecal incontinence
dyspareunia
psychological

Question 10

What IP care does midwife give?

Answer 10

Position
Extra midwife at birth 
Assess throughout
Communication
Hands-on
Episiotomy if required
SLOWLY

Question 11

PN care for perineal tears?

Answer 11

ABX to reduce infection (RCOG, 2010)
Physio referral recomended (RCOG, 2010)
R/v at 6-12 weeks for anal sphincter damage (RCOG, 2010)
Pain or discomfort should be referred to gynaecologist
Wound assessed at midwife visits
Pain relief
Informed of signs of infection and hygiene
Sexual intercourse 2-6 weeks post birth (NICE, 2015)
Routine observations on Amy to assess for infection.