3rd and 4th degree perineal tears that occurs during vaginal delivery

Abstract

Objective: Perineal injuries are common in vaginal delivery. In this study, we aimed to investigate the factors affecting the degree of perineal injury and the effect of injury degree on incontinence. Methods: Fifteen patients, underwent sphincter repair by the general surgery unit, who had perineal tear during normal vaginal delivery between January 2018 and March 2019 in our hospital and were retrospectively evaluated. Those with grade 3a and 3b perineal tears were divided into 2 groups as group-1, and those with grade 3c and grade 4 perineal tears as group-2. Episiotomy type, fetal characteristics [head circumference and birth weight], early postoperative continence findings were compared in between groups. Results: The average age of the patients was 30 ± 8.7 years. When the groups were compared, there was no significant superiority of episiotomy in terms of perineal injury (p=0.07). 4 patients had 3a, 3 patients had 3b, 6 patients had 3c and 2 patients had fourth-degree perineal injuries. The average birth weight of the newborns was 3438 ± 492 g, and the head circumference was 34.33 ± 1.23 cm. There was no significant difference in incontinence between the groups (p=0.55). Conclusıon: The treatment of anorectal injuries is surgery. The method of treatment varies according to the time elapsed between injury and intervention, fecal contamination, degree of injury, general condition of the patient, presence of accompanying injury, experience and preference of surgeon. We think that sphincter damage during delivery can be looked after successfully with early diagnosis and intervention before tissue edema develops.