In this article we explore the classification of perineal tears, explaining what it means to have a first, second, third or fourth degree tear.
What is a perineal tear?
A perineal tear is an injury to the perineum and surrounding structures sustained during the vaginal delivery of a baby.
Degrees of perineal tear
The classification of perineal tears happened relatively recently and has enabled medical practitioners to differentiate perineal injuries more accurately.
There are varying degrees of perineal tear. They range from a first degree tear to a fourth degree tear. It is a sliding scale with a first degree tear being the least severe and a fourth degree tear being the most severe.
The clinical presentation of each can be described as follows:
- First degree: laceration of the vaginal epithelium or perineal skin only
- Second degree: involvement of the perineal muscles but not the anal sphincter
- Third degree: disruption of the anal sphincter muscles, which is further subdivided into:
- Grade 3a: less than 50% thickness of external anal sphincter torn
- Grade 3b: more than 50% thickness of external anal sphincter torn
- Grade 3c: internal anal sphincter also torn
- Fourth degree: a third degree tear with disruption of the anal epithelium
Diagnosing a perineal tear
After a vaginal delivery, a medical practitioner should examine a patient to see whether she has suffered a perineal tear. Not all women will have one so there may be no injury present. But if there is an injury, the clinician must establish the extent of the damage and classify the tear according to the guidelines described above.
If there is any doubt as to the severity of the injury, a more senior clinician should be asked to attend and advise.
The standardised classification of perineal tears has greatly improved the ability of medical practitioners to make an accurate diagnosis. Consequently more and more medical practitioners are detecting and reporting 3rd and 4th degree tears – evidenced by the fact that incidence rates are rising.
Failure to detect perineal tear
Despite these improvements, there are times when a 3rd or 4th degree tear goes undiagnosed. This might be due to clinician incompetence, or it might be because an examination was not carried out.
When a severe perineal tear is not detected, the standard of care will judged unacceptable. The patient may therefore be entitled to claim compensation for the damages incurred. Contact us for more information.