Perineal Laceration

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Top Contributors - Kehinde Fatola, Kalyani Yajnanarayan, Oyemi Sillo and Temitope Olowoyeye

Introduction

Perineal trauma, also known as vagina tear, is a very typical and expected side effect of vaginal delivery. Lacerations on the perineum, cervix, vagina, and vulva can occur spontaneously or iatrogenically, as with an episiotomy. Long term complications are not expected in most vaginal tears, except in severe lacerations which are associated with chronic pelvic floor dysfunctions and painful intercourse. Risk factors include nulliparity, operative vaginal delivery, midline episiotomy, Asian race, increased fetal weight, malpresentation and advanced gestational age.

Clinically Relevant Anatomy

The mons pubis, labia minora and majora, clitoris, perineal body, and vaginal vestibule are all part of the female external genitalia. Between the anus and the vestibular fossa is the perineal body. It is the most common location of laceration during childbirth because it encompasses the superficial and deep muscles of the perineal membrane.

Epidemiology

More than 53-89 percent of women will have some form of perineal laceration during delivery. The majority of perineal lacerations that occur during a vaginal delivery are of the first or second degree. Suturing will be required for 60-70 percent of these lacerations. In the United States, the incidence of OASIS injuries ranges from 4 to 11 percent for women. Perineal trauma becomes less common and less severe with each additional birth.

Classification

First degree: superficial vaginal mucosa injury that may involve the perineal skin.

Second Degree; First-degree laceration involving the vaginal mucosa and perineal body.

Third Degree: a second-degree laceration involving the anal sphincter. This is further subdivided into three categories:

• A: Only about half of the anal sphincter is torn.
• B: More than half of the anal sphincter is torn.
• C: Torn external and internal anal sphincters.

Fourth degree:Third-degree laceration of the rectal mucosa.

Obstetric anal sphincter injuries refer to severe perineal lacerations, which include third- and fourth-degree lacerations (OASIS)

Episiotomy

An episiotomy is a procedure performed during the second stage of labor that causes posterior vaginal enlargement. This is done shortly before delivery to reduce maternal blood loss. An episiotomy may be indicated if the fetus must be delivered quickly, if there is soft tissue dystocia, or if an operative vaginal delivery is required. Midline and mediolateral are the two most common types of episiotomies, restricted use of episiotomy is recommended by the World Health Organization (WHO).

Diagnostic Procedures

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Outcome Measures

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Management / Interventions

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Differential Diagnosis

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Resources

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