When a patient sustains a perineal tear during a vaginal delivery, it must be repaired shortly after the birth. The nature of the repair will depend upon the severity of the tear.
Treating first and second degree tears
First and second degree tears are more minor injuries than third and fourth degree tears. They can be defined as follows:-
- First degree tear: laceration of the vaginal epithelium (the tissue lining the vagina) or perineal skin only.
- Second degree tear: laceration of the perineal muscles and fascia as well as the vaginal epithelium and perineal skin. The anal sphincter is not involved.
Because first and second degree tears are relatively minor injuries, they can be repaired by a midwife in the delivery suite. There is no need for a patient to be sent to theatre or for a more senior medical professional to carry out the repair. A reasonably competent midwife should be able to diagnose the injury and suture the wound with dissolvable stitches.
Treating third and fourth degree tears
However, third and fourth degree tears are much more serious injuries. They can be defined as follows:-
- Third degree tear: laceration of the anal sphincters, as well as the vaginal epithelium, perineal skin, perineal body. Third degree tears can be further subdivided into:
- partial tear of the external sphincter involving less than 50% thickness;
- tear of the external sphincter involving more than 50% thickness;
- external and internal sphincter torn;
- Fourth degree tear: the same as a third degree tear, but the injury extends to the tissue underneath (the anal epithelium).
Because of the severity of these tears, they must be repaired:-
- By an experienced surgeon;
- In the operating theatre;
- Under good lighting.
A third or fourth degree tear may be diagnosed by a midwife, and indeed, any reasonably competent midwife should be able to do so. If a midwife is in any doubt, advice should be sought from a more senior medical professional. Once diagnosed, a repair should not be carried out until an experienced surgeon is available to perform the repair in theatre.
Failure to repair third and fourth degree tears
Unfortunately we often hear from women whose third and fourth degree tears were not properly repaired. Normally this occurs because the injury was not diagnosed and she was instead treated for a more minor injury, such as a first or second degree tear. Only when she begins to suffer problems later down the line is an accurate diagnosis obtained. It can also be the case the a third or fourth degree tear is diagnosed, but the repair is performed to a poor standard.
If you have suffered because of an unrepaired or poorly repaired tear, get in touch with us today.
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