Abstract
Aim: The aim of this article is to present the knowledge of current literature regarding epidemiology and predisposing factors, classification and surgical treatment of third degree perineal tears. Materials and Methods: We reviewed current articles in English language from medline and Pub-Med using as key words “vaginal repair, third degree tear, episiotomy and vaginal delivery”. We summarized literature regarding predisposing factors, epidemiology, prevention and surgical treatment of third degree perineal tears. Results: it is demonstrated today by several studies that widespread episiotomy is responsible for the increasing frequency of 3rd degree lace-rations of the perineum which are significantly associated with forceps and the use of gynecological chair (boom) for vaginal delivery. Primiparous women with babies weighting >4 kgr, are at greater risk. Two types of surgical repair: end-to-end approximation and overlapping of torn ends of the anal sphincter, are both related to the functional outcome of the repair. Conclusion: Episiotomy is an important risk factor for severe lacerations after vaginal delivery. Midline episiotomy and assisted vaginal delivery should be avoided whenever possible, especially in the presence of a large baby. Recent evidence suggests that there is no significant advantage between overlap repair and approximation technique, with regard to fecal incontinence.
Highlights
Third degree perineal lacerations are known since the time of Hippocrates
Materials and Methods: We reviewed current articles in English language from medline and Pub-Med using as key words “vaginal repair, third degree tear, episiotomy and vaginal delivery”
Results: it is demonstrated today by several studies that widespread episiotomy is responsible for the increasing frequency of 3rd degree lacerations of the perineum which are significantly associated with forceps and the use of gynecological chair for vaginal delivery
Summary
Third degree perineal lacerations are known since the time of Hippocrates. They involve a tear in the vagina, skin, muscles between the vagina and anus Degree of laceration Superficial laceration of the vaginal mucosa or perineal body. Laceration of the vaginal mucosa and/or perineal skin and deeper subcutaneous tissues. Second degree laceration with laceration of the capsule and part (but not all) of the anal sphincter muscle. As above with complete laceration of the anal sphincter muscle. Complete third degree laceration with laceration of the rectal mucosa. Episiotomy is the overriding determinant of third-degree lacerations [2]. The aim of this article is to review the current literature regarding epidemiology, predisposing factors, classification and surgical treatment of third degree perineal tears
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