In this article we explain how to recognise a third degree tear after a vaginal delivery. If medical professionals fail to diagnose the injury, there could be grounds for a compensation claim.
Diagnosing a third degree tear
According to NICE guidelines, a woman who is suspected of having torn during a vaginal delivery should be examined shortly after the birth, either by a midwife or a doctor. The procedure that must be followed is outlined below:-
- Informed consent should be obtained for a vaginal and rectal examination.
- There must be good exposure of the perineal injury and if this is not possible then a women should be placed in lithotomy.
- To enable visibility of the injury, good lighting is essential.
- If the examination is restricted because of pain, adequate analgesia must be given prior to examination.
- Following a visual examination of the genitalia, the labia should be parted and a vaginal examination should be performed to establish the full extent of the vaginal tear.
- When multiple or deep tears are present it is best to examine and repair in lithotomy.
- The vagina must be exposed by parting the labia with the index and middle fingers of the other hand.
- The apex of the vaginal laceration should always be identified.
- A rectal examination should then be performed to exclude injury to the anorectal mucosa and anal sphincter.
- By inserting the index finger in the anal canal and the thumb vagina, the anal sphincter can be palpated by performing a pin-rolling motion.
- If there is any uncertainty, a woman should be asked to contract her anal sphincter (this will only be possible in the absence of a working epidural). If the anal sphincter is disrupted, there will be a distinct gap felt in the anterior aspect of the anus.
- If there is still uncertainty, a more senior opinion should be sought.
Failure to diagnose a third degree tear
With these steps, any competent medical practitioner should be able to identify a third degree tear. A repair can then be carried out in theatre by an experienced surgeon, giving a patient the best chance of making a full recovery.
If a third degree tear is not diagnosed shortly after the birth, but is discovered weeks/months/years later, questions must be raised as to why this happened. If an examination was not performed, or it was carried out by an incompetent practitioner, there will be grounds for a medical negligence compensation claim. Contact us today to find out more.
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