Third degree perineal lacerations-How, why and when? A review analysis

Abstract

Aim: The aim of this article is to present the know-ledge 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 Eng-lish language from medline and Pub-Med using as key words " vaginal repair, third degree tear, episi-otomy and vaginal delivery " . We summarized litera-ture 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 respon-sible for the increasing frequency of 3rd degree la-cerations of the perineum which are significantly as-sociated 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 approxima-tion and overlapping of torn ends of the anal sphinc-ter, 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 pre-sence of a large baby. Recent evidence suggests that there is no significant advantage between overlap re-pair and approximation technique, with regard to fecal incontinence.