Repair of episiotomy or perineal injury

1. Big picture

Perineal trauma is common after vaginal delivery. Most injuries are minor, but the examiner cares about one dangerous point:

Never miss an obstetric anal sphincter injury.

A good oral-exam answer should follow this logic:

After vaginal birth
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Assess bleeding and maternal stability
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Inspect vulva, vagina, cervix, perineum, and anus
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Classify the tear accurately
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Give adequate analgesia and asepsis
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Repair layer by layer
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Perform rectal examination after repair
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Prevent infection, pain, wound breakdown, incontinence, and dyspareunia