If your fourth degree tear was not diagnosed and repaired after you gave birth, you could be entitled to claim compensation for medical negligence. Contact us today for more information.
Assessment after vaginal delivery
All women who are suspected of having sustained perineal trauma must undergo a digital rectal examination. Risk factors that should prompt such an examination include first vaginal delivery, extended episiotomy, occipito-posterior positon and forceps delivery.
If a tear is identified, an appropriate repair should be carried out. If a first or second degree tear is diagnosed, the injury can be repaired by a midwife (or someone more senior) in the delivery suite. If a third or fourth degree tear is diagnosed, a repair should be carried out by a surgeon in theatre.
Repairing a fourth degree tear
A fourth degree tear is the most severe type of perineal injury. It involves the perineal skin, perineal muscles, anal sphincter muscles and anal epithelium.
If the external anal sphincter is completely torn (as it will be with a fourth degree tear) there are two techniques of repair: an end-to-end repair or an overlap repair. Either technique can be used depending upon operator expertise. Usually two mattress sutures for an end-to-end repair and four mattress sutures for an overlap repair are sufficient.
However, ‘figure of 8’ sutures should not be used as they are haemostatic sutures and can cause ischaemia (lack of oxygen due to disrupted blood flow) and possible necrosis (which is when the tissue dies).
After the repair is complete, another digital rectal examination must be performed. The purpose of the second rectal examination is to check that sutures have not been inadvertently inserted into the rectum.
Failure to repair a fourth degree tear
If a fourth degree tear is not repaired, it is very likely that a patient will go on to develop faecal incontinence.
Continence depends on anatomically and functionally intact sphincters, formed stools and, to some extent, on a ‘non-irritable’ colon and rectum. Women with unrepaired fourth degree tears will not have sphincter muscles that are intact. Because of this defect, a patient will find that she is unable to defer defecation, resulting in episodes of incontinence.
If a fourth degree tear is not repaired due to medical error and these complications arise, there will be a case of medical negligence. For example, if the tear was not diagnosed or the tear was not repaired with a suitable technique.
To find out if you can claim for a fourth degree tear, get in touch with us today.