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

A complete perineal tear cuts through the anal sphincter and sometimes the rectal wall. The question wants the delivery scenario that most often produces this severe injury.

1. Face to pubes delivery: here the baby is born face first, in a persistent occipito posterior position, presenting the mento vertical diameter. This diameter is much wider than the usual diameter in a normal delivery, so it overstretches the perineum and is the classic setup for a complete tear.
2. Breech delivery: the aftercoming head can be a concern, but with careful technique this is not the standard cause of complete perineal tears compared with face to pubes birth.
3. Internal podalic version: this is a manoeuvre to turn a baby into breech, usually for a second twin, and does not by itself explain a complete perineal tear.
4. Manual removal of placenta: this happens after delivery of the baby is already finished, so it plays no role in perineal stretching during birth of the head.

Since the wide mento vertical diameter of a face to pubes delivery puts the most direct strain on the perineum, it is the setting most linked with complete perineal tears.

Let's summarize:

• A wider presenting diameter through the vulva raises the risk of severe perineal tears.
• Face to pubes delivery, from persistent occipito posterior position, gives the widest such diameter among the options.

So the answer is face to pubes delivery.