Obstetric Perineal Injury. Max Brinsmead PhD FRANZCOG March 2013. Subjects to be covered:. Definitions Some anatomy Repair of 2 nd degree obstetric injury Risk factors for 3 rd & 4 th degree tears The identification of 3 0 & 4 0 tears Management of 3 0 & 4 0 tears
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Max Brinsmead PhD FRANZCOG
An evidence-based approach
There are no prospective trials and only a few retrospective studies
The risk of repeat 30 and 40 trauma is similar to the original incidence
There is some evidence that if the woman is asymptomatic then vaginal birth does not further increase the risk of those symptoms
There is some evidence that for symptomatic women then vaginal birth does increase the severity of those symptoms