Tears

Question 1

Repair of IAS

Answer 1

If can be identified, repair this separately with interrupted or mattress sutures without any attempt to overlap the IAS

Question 2

Which techniques to repair EAS

Answer 2

• if full thickness EAS, either overlapping or an end to end method can be used - equivalent outcomes
• for partial thickness, end to end

Question 3

What suture for anorectal mucosa

Answer 3

3.0 polyglactin

Question 4

What suture for EAS/IAS

Answer 4

3.0 PDS

Or 2.0 polyglactin

Question 5

Post op management

Answer 5

Broad-spectrum antibiotics
Laxatives
PT
Review 6-12 PP

Question 6

Percentage asymptomatic at one year

Answer 6

60-80%

Question 7

Option of caeser birth

Answer 7

Symptomatic or

Abnormal endoanal USS

Question 8

Incidence of OASIS

Answer 8

2.9%
Primip 6.1%
1.7% multip

Question 9

Anal incontinence

Answer 9

Complaint of involuntary loss of flat is and/or farces affecting QOL

Question 10

Risk factors for OASIS

Answer 10

Asian
Nullip
>4000g
Shoulder dystocia
OP
Prolonged second stage (increases with duration)
Instrumental delivery
 Ventouse w/o epis 1.89
 Ventous w epis 0.57
 Forceps w/o epis 6.53
 Forceps w epis 1.34

Question 11

Methods of perineal protection

Answer 11

Left hand slowing delivery of the head
Right hand protecting perineum
Mother not pushing when head crowning
Think about epis

Question 12

Warm compress RR

Answer 12

0.48

Question 13

Perineal massage RR and NNTB

Answer 13

0.91

NNTB 1:15

Question 14

When can an overlap technique be used

Answer 14

Full thickness EAS only

Question 15

Risk of further oasis when already had one

Answer 15

5-7%

17% develop worsening faecal symptoms after a second NVD - occur usually when faecal incontinence >3months but <6months PP