A fourth degree tear is a serious perineal injury sustained during a vaginal delivery. It must be diagnosed shortly after the birth.
How is a fourth degree tear diagnosed?
A fourth degree tear should be diagnosed soon after the delivery during a routine examination. All women who have a vaginal delivery are supposed to be examined afterwards to ensure any injuries are recognised and repaired.
The examination can be carried out by either a midwife or a doctor. A patient should be advised of the need to perform an examination before being given sufficient pain relief. The practitioner should then visually assess the genitalia before inserting a thumb into the vagina and a finger into the anus. This will verify whether or not the anal sphincter has sustained any damage.
If the practitioner is in any doubt as to the type of injury that has been suffered, a more senior opinion should be sought.
As long as an examination is carried out by a competent medical practitioner, it will be possible to diagnose a fourth degree tear.
Delayed diagnosis of a fourth degree tear
Some women, however, only discover they have a fourth degree tear weeks, months or even years after the delivery. This happens because medical practitioners fail to diagnose the injury shortly after the birth – either because an examination was not performed, or because the tear was overlooked. The tear is only diagnosed later when a woman seeks help for the onset of symptoms, usually relating to faecal incontinence and urgency.
The problem with a delayed diagnosis is that the injury cannot be repaired as effectively. If the tear is sutured shortly after birth, a patient stands a good chance of making a full recovery. But if treatment is delayed, the chances of a patient regaining normal function are diminished. It is possible to carry out a surgical repair, and try other forms of treatment such as sacral nerve stimulation. Nevertheless, these will not be as successful as a primary repair.
Compensation for a delayed diagnosis
A missed fourth degree tear is considered negligent on the part of medical professionals. Indeed, such injuries should be diagnosed and repaired soon after the birth; a failure to do so will be deemed unacceptable. If this causes a patient to suffer complications such as faecal urgency, there will be grounds for a medical negligence compensation claim. Contact us to find out more.