TITLE:
Third degree perineal lacerations-How, why and when? A review analysis
AUTHORS:
Angelos Daniilidis, Vasilis Markis, Menelaos Tzafetas, Panagiotis Loufopoulos, Panagiotis Hatzis, Nikolaos Vrachnis, Konstantinos Dinas
KEYWORDS:
Vaginal Repair; Third Degree Tear; Episiotomy; Vaginal Delivery
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.2 No.3,
September
7,
2012
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.