Vaginal Lacerations

Question 1

MC site of vaginal tear

Answer 1

perineal body: dense connective tissues includes superficial and deep transversals muscles and attachments of the bulbocavernosus.

Question 2

3rd degree tear definition

Answer 2

injury to perineum involving anal sphincter complex

Question 3

3a

Answer 3

less than 50% of external anal sphincter thickness torn

Question 4

3b

Answer 4

more than 50% external sphincter torn

Question 5

3c

Answer 5

both external and internal sphincter torn

Question 6

4th degree definition

Answer 6

anal sphincter complex (internal and external) and anal canal epithelium

Question 7

prevalence of 3rd degree

Answer 7

3.3%

Question 8

prevalence of 4th degree

Answer 8

1%

Question 9

episiotomy, when to do

Answer 9

clinical judgement, no guidelines.

midline most common in US

Question 10

SVD and pelvic floor dysfunction

Answer 10

increased risk of pelvic floor reconstruction if have SVD

Question 11

warm compress

Answer 11

reduces incidence of 3rd and 4th degree lacs

Question 12

episiotomy

Answer 12

restrictive use over routine use

mediolateral (more painful) preferred over midline (hurts anus)

Question 13

1st degree repair with

Answer 13

suture or glue okay

Question 14

2nd degree perineal repair

Answer 14

suture or glue

Question 15

OASIS post op recs:

Answer 15

• stool softeners and oral laxatives

Question 16

prior OASIS risk another

Answer 16

• absolute risk is low, but CS is okay to consider

Question 17

If internal anal sphincter can be adequately identified then repair can be done with

Answer 17

1) distal portion of the reinforcing second layer of the rectal muscular with 3-0 polyglactin (vicryl) or
2) separately from the external anal sphincter using 30-0 monofilament monofilament PDS