Perineal tears

Question 1

How can perineal tears be categorised?

Answer 1

first degree
second degree
3rd degree*
4th degree

3rd: split into 3a, 3b, 3c

Question 2

What is a 1st degree tear?

Answer 2

superficial damage, no muscle involvement

No repair needed

Question 3

What is a second degree tear and how is it managed

Answer 3

Injury to perineal muscle, not involving any sphsincter

suturing on ward by midwife of clinician

Question 4

What is a 3rd degree tear generally?

Answer 4

Involved the perineum INCLUDING the anal sphincter

Question 5

What is a 3a tear?

Answer 5

less than 50% external anal sphincter torn

Question 6

What is a 3b tear?

Answer 6

more than 50% of external sphincter torn

Question 7

What is 3C tear?

Answer 7

internal sphincter torn

Question 8

How to manage all grade 3 perineal tears?

Answer 8

Repair in theatre

Question 9

What is a fourth degree tear and how it is managed?

Answer 9

injury to perineum, involving external AND internal sphincter AND recta mucosa

• repair in theatre

Question 10

Risk factors for perineal tears?

Answer 10

Primigravida

Large babies

Shoulder dystocia

Forceps delivery