Third degree perineal lacerations-How, why and when? A review analysis

Angelos Daniilidis, Vasilis Markis, Menelaos Tzafetas, Panagiotis Loufopoulos, Panagiotis Hatzis, Nikolaos Vrachnis, Konstantinos Dinas

Department of Obstetrics and Gynaecology, Ateraieio Hospital, Athens, Greece.
Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.

DOI: 10.4236/ojog.2012.23064                

Abstract

Aim: The aim of this article is to present the knowledge of current literature regarding epidemiology and predisposing factors, classification and surgical treatment of third degree perineal tears. Materials and Methods: We reviewed current articles in English language from medline and Pub-Med using as key words “vaginal repair, third degree tear, episiotomy and vaginal delivery”. We summarized literature regarding predisposing factors, epidemiology, prevention and surgical treatment of third degree perineal tears. Results: it is demonstrated today by several studies that widespread episiotomy is responsible for the increasing frequency of 3rd degree lace-rations of the perineum which are significantly associated with forceps and the use of gynecological chair (boom) for vaginal delivery. Primiparous women with babies weighting >4 kgr, are at greater risk. Two types of surgical repair: end-to-end approximation and overlapping of torn ends of the anal sphincter, are both related to the functional outcome of the repair. Conclusion: Episiotomy is an important risk factor for severe lacerations after vaginal delivery. Midline episiotomy and assisted vaginal delivery should be avoided whenever possible, especially in the presence of a large baby. Recent evidence suggests that there is no significant advantage between overlap repair and approximation technique, with regard to fecal incontinence.

Keywords

Vaginal Repair; Third Degree Tear; Episiotomy; Vaginal Delivery

Conflicts of Interest

The authors declare no conflicts of interest.

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