Perineal tear (Complete) Flashcards
(14 cards)
Define perineal terar
Laceration occuring between the vaginal opening and the anus during vaginal childbirth
What percentage of vaginal birth deliveries result in perineal tear?
85%
What risk factors are associated with perineal tear?
First-time delivery
Macrosomia
Prolonged delivery
Instrumental delivery (esp forceps)
What are the main classifications of perineal tear?
First degree
Second degee
Third degree (3a, 3b, 3c)
Fourth degree
What is considered a first degree perineal tear?
Superficial tear with no muscle involvement
How is a first-degree perineal tear managed?
No management required
What is considered a second-degree perineal tear?
Extends to perineal muscles and fascia
Anal sphincter intact
How is second-degree perineal tears managed?
Suturing on the ward via experienced midwife or clinician
What is considered a third degree tear?
Tear involving anal sphincter complex (external and internal anal sphincter)
3a: < 50% involvement of EAS
3b: >50% involvement of EAS
3c: Involvement of IAS
Anal mucosa is intact
How is a third degree perineal tear managed?
Surgical repair
Post-op AB and laxatives
What is considered a fourth degree tear?
Involvement of anal sphincter complex and anal/rectal mucosa
How is a fourth degree perineal tear managed?
Surgical repair
Post-op AB and laxatives
What complications are associated with 3rd and 4th degree tears?
Faecal incontinence
Urinary incontinence
Dyspareunia
What preventative surgical measure can be taken to reduce risk of perineal tears in suscpetible deliveries?
Episiotomy
(Typically done mediolaterally to avoid anal sphincter damage)
Used especially in instrumental delivery
