Question

Complete perineal tear is common in

• A. Face to pubes delivery
• B. Breech delivery
• C. Internal podalic version
• D. Manual removal of placenta

Hint:

Think about which delivery presents the widest diameter through the vulva.

Answer 1

The Correct Option is A

Step 1: Understanding the Question:
A complete (third or fourth degree) perineal tear extends through the perineal body into the anal sphincter, and sometimes into the rectal mucosa. The question asks which delivery situation raises the risk of this severe tear the most.

Step 2: Key Formula or Approach:
The risk of a complete tear rises whenever the fetal head presents to the vulva with a larger than normal diameter, stretching the perineum beyond what it can safely take.

Step 3: Detailed Explanation:
In a face to pubes delivery, the head is in the persistent occipito posterior position and is born with the face rotating under the pubic arch. This presents the mento vertical diameter, which is considerably wider than the diameters seen in a normal occipito anterior delivery, so it puts far more stretch on the perineum.
Breech delivery mainly stresses the head last, but this is usually managed with controlled techniques and does not carry the same high, direct risk of complete perineal tear as a face to pubes birth.
Internal podalic version is a manoeuvre used to turn a baby, most often the second twin, into a breech position for delivery, and by itself is not the classic cause of a complete tear.
Manual removal of placenta is a step done after the baby is already born, so it has no bearing on how much the perineum stretched during the birth of the head.

Step 4: Final Answer:
Complete perineal tear is most linked with face to pubes delivery, option (A), because of the wide mento vertical diameter that must pass through the vulva.