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  • Dr.Niraj Mahajan
  • Dr.Niraj Mahajan
  • Dr.Niraj Mahajan
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    By AdminPosted On 05-Oct-2016

    1. Deep Episiotomy and Perineal Tear

    While suturing deep episiotomy you notice that the external anal sphincter is mostly torn, with a few fibres left intact. The internal anal sphincter is intact. How would this tear be described?a) Second-degree tear b) Third-degree tear, 3a c) Third-degree tear, 3b d) Third-degree tear, 3c e) Fourth-degree tearCorrect Answer: c) Third-degree tear, 3b.
    3a: less than 50% external anal sphincter involvement.
    3b: more than 50% external anal sphincter involvement.

    3c: both external and internal sphincter involvement.
    It is essential that the appropriate diagnosis is made. A third-degree tear should be repaired in theatre under adequate light and by a trained surgeon.

    2. Mediolateral Episiotomy

    Compared with a midline episiotomy , an advantage of mediolateral episiotomy

    a) ease of repair
    b) fewer break downs
    c) less blood loss
    d) less dyspareunia
    e) less extension of the incision

    Correct Answer: e) less extension of the incision. A mediolateral episiotomy involves cutting into more muscle tissue and does not follow the natural way a woman would tear. The midline episiotomy involves cutting through less muscle tissue and following the natural line of the perineum that a tear would take if it occurred. This can mean they are easier to repair, involve less blood loss, heal better, and have less scarring and possibly less pain in the early weeks after the birth.The disadvantages of midline episiotomy: increases the chances of the cut extending through to the anus and causing a 3rd or 4th degree tear. In one study the incidence was shown to be as high as 24% extending in this way.

    3. Muscles of Perineum

    Which three muscles form the superficial group of muscles of the perineum?a) Bulbospongiosus, superficial transverse perineal muscle, and ischiocavernous b) Deep transverse perineal muscle, external anal sphincter, and bulbospongiosus c) External vaginal sphincter, deep transverse perineal muscle, and external anal sphincter d) Iliococceageus, ischiocavernosus, and bulbospongiosus e) Levator ani, ischiocavernous, and bulbospongiosusCorrect Answer: a) bulbospongiosus, superficial transverse perineal muscle and ischiocavernous. These three muscles make up the superficial group of perineal muscles. The bulbospongiosus is superficial to the Bartholin's glands. 

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    Dr. Niraj Mahajan

    MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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