Perineal Trauma

Question 1

What is a 1st degree tear?

Answer 1

Injury to skin and/or vaginal mucosa

Question 2

What is a 2nd degree tear?

Answer 2

Injury to perineal muscle excluding the anal sphincter

Question 3

What is a 3rd degree tear?

Answer 3

3a - <50% of EAS
3b - >50% of EAS
3c - both EAS and IAS

Question 4

What is a 4th degree tear?

Answer 4

Injury to anal sphincter complex that extends into the rectal lumen through the rectal mucosa

Question 5

What is an OASI?

Answer 5

Obstetric Anal Sphincter Injury (3rd/4th degree)

Question 6

What can the anal sphincter do?

Answer 6

• Differentiate between solids, liquids and gases
• Tell whether the person is alone or not
• Tell whether the person is standing or sitting
• Tell whether the person has their underwear on or off

Question 7

What are the risk factors for OASI?

Answer 7

• Primip
• Asian ethnicity
• FGM
• BMI <25
• BW >4kg/shoulder dystocia
• Precipitate 1st/2nd stage

Question 8

What effect does an OASI have on the body?

Answer 8

• Incontinence (flatus/faeces)
• Urgency when toileting
• Pain
• Sexual problems

Question 9

How should an OASI be managed?

Answer 9

• Repair in theatre by obstetrician
• OASI clinic
• See at 16 weeks PN
• Physiotherapy referral
• Lactulose

Question 10

How should an episiotomy be performed?

Answer 10

Mediolaterally towards the woman’s right side

Question 11

What are the indications for performing an episiotomy?

Answer 11

• Poor progress in 2nd stage due to tight perineum
• Instrumental deliveries
• Shoulder dystocia
• Malpresentation
• FGM
• Buttonholing

Question 12

What is buttonholing?

Answer 12

Perineum is pulled so tight that holes appear - if these are near the anal sphincter, an episiotomy should be performed

Question 13

Why is timing of an episiotomy important?

Answer 13

Too early = PP not pressing on perineum and will not have displaced the levator ani muscles = more bleeding

Question 14

What are some ways in which perineal trauma can be minimised?

Answer 14

• Perineal massage
• Birthing positions
• Hands on
• Warm compress during 2nd stage
• Episiotomy

Question 15

What birthing position is optimal for preventing perineal trauma?

Answer 15

R/L lateral

Question 16

What should be given for pain relief following suturing?

Answer 16

Diclofenac 100mg PR

Question 17

What does PEACHES stand for?

Answer 17

P - position at birth
E - extra midwife
A - assess perineum throughout labour
C - communicate
H - hands on
E - episiotomy
S - slow delivery

Question 18

What is postpartum sexual dysfunction?

Answer 18

Impaired/ inadequate ability of a woman to engage in/enjoy satisfactory intercourse or orgasm following childbirth

Question 19

When should suturing be performed for a pool birth?

Answer 19

1 hour after getting out of the pool due to increased risk of infection

Question 20

Which needles should be used for suturing?

Answer 20

2-0 (thicker) = muscle

3-0 (thinner) = skin