(c) Third degree-tear of the vaginal and perineal mucous membrane,
the perineal muscles, and the capsule of the rectal sphincter.
(d) Fourth degree-tear of the vaginal and perineal mucous membrane,
the perineal muscles, and through the rectal sphincter and anterior wall of the rectum.
(a) Rapid descent of the fetus.
Pushing prior to complete cervical effacement and dilatation.
(d) Forceps application.
Uncontrolled, forceful extension of the fetal head.
Signs and symptoms.
Obvious body injury after delivery of the infant--if perineal
(b) Bright red bleeding despite a well toned fundus-if vaginal or cervical
laceration and not detected at time of delivery.
(c) Signs of shock-rapid, thready pulse, falling blood pressure,
increasing anxiety of the patient.
(a) Suturing of the laceration.
(b) Vaginal packing.
Blood transfusions if the patient's hematocrit is low and the patient
(a) Observe closely for continued vaginal bleeding.
(b) Monitor the patient's vital signs.
(c) Flag the patient's chart for vaginal packing in place. This is helpful
to the nurse who is checking for vaginal bleeding doesn't mistake a lack of obvious
signs of blood for no bleeding. The vaginal packing could "hide" a hemorrhagic episode