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Eliz Achhami
Intern Dr. Dipesh Bikram Shah
Shree Birendra Hospital
Kathmandu
Case of Perineal Tear
• 20 years G2P0+1 post dated pregnancy (at 39+4 weeks
of gestation, according to 1st USG scan) was admitted
to maternity ward for planned induction of labor.
• On examination:-
– General condition was fair
– No Pallor, icterus, dehydration or edema
– Vitals –
• Pulse:-88 bpm, regular
• B.P.:-110/70 mm of hg
• Temperature:-98º F
• Respiratory Rate:-22 Breaths/min
• P/A:-
o Uterus-term size
o cephalic presentation 4/5 palpable
o with no uterine contraction
o FHS -144 bpm, regular
• P/V:-
o os - tip of finger
o Cervix - soft, uneffaced , posterior
o Head station at -2
o Bishop’s score - 3
1)Obstetrical causes
These included
periurethral lacerations
SECOND DEGREE PERINEAL TEAR:
• Extend farther to
involve the anal
sphincter
FOURTH DEGREE PERINEAL
TEAR:
• Extends through the rectum's mucosa to expose its
lumen.
How to recognize:
• Put the patient in extended lithotomy position.
• Arrange proper spotless bright light.
• Vulva should be examined stepwise right from clitoris
to the anus downwards, laterally paraclitoral,
paraurethral, paravaginal and pararectal skin and
muscles in every case after delivery.
• Perineal tears may be associated with high vaginal
circular tears and tears in the fornix and cervix.
• One should suspect traumatic PPH due to perineal tears
when continuous bleeding p/v persisting even after
delivery of placenta when uterus is contracted and
retracted.
PERINEAL TEARS (1st & 2nd degree)&
EPISIOTOMY (induced 2nd degree) REPAIR: