Repair of the 3rd and 4th degree obstetric perineal tear

Authors: V. Kališ 1;  B. Bednářová 1;  J. Štěpán jr. 2;  Z. Rokyta 1
Authors‘ workplace: Gynekologicko-porodnická klinika LF UK a FN Plzeň, přednosta doc. MUDr. Z. Rokyta, CSc. 1;  Sanatorium Sanus, Hradec Králové 2
Published in: Ceska Gynekol 2010; 75(4): 284-291


Summary of the current knowledge of repair of obstetric anal sphincter trauma.


Department of Gynecology and Obstetrics, Charles University and University Hospital Pilsen.

Review of the current international literature covering the given problem. RCOG classification of obstetrics perineal trauma should always be used as it respects the anatomic structures together with the physiological functions of tissue involved in ano-rectal continence.

Two types of procedure:
end-to-end approximation and overlapping of torn ends of the anal sphincter are both referred to and they are discussed with regards to the functional outcome of the repair.

Operating conditions:
experience of the surgeon, operating theatre and its equipment, asepsis, lighting, operating instruments, anesthesia, material and type of suture, medication is described to increase the effectiveness of the repair. A delay in primary repair of up to 8-12 hours does not seem to be detrimental to the functional outcome of the procedure.

Uncommon types of injury mentioned:
segmented tear of internal anal sphincter, lateral tear of external anal sphincter.

Key words:
perineal tear, third and fourth degree tear, perineal trauma, ano-rectal incontinence, classification, repair.


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Paediatric gynaecology Gynaecology and obstetrics Reproduction medicine
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