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Case 56 - A 20-Year-Old with a Fourth-Degree Perineal Laceration

from Section 6 - Intrapartum/Delivery

Published online by Cambridge University Press:  08 April 2025

By
L. David Moore
Edited by
Peter F. Schnatz ,
D. Yvette LaCoursiere ,
Christopher M. Morosky ,
Jonathan Schaffir ,
Vanessa Torbenson  and
David Chelmow
Peter F. Schnatz
Affiliation:
The Reading Hospital, Pennsylvania
D. Yvette LaCoursiere
Affiliation:
University of California, San Diego
Christopher M. Morosky
Affiliation:
University of Connecticut School of Medicine
Jonathan Schaffir
Affiliation:
The Ohio State University College of Medicine
Vanessa Torbenson
Affiliation:
Mayo Clinic Alix School of Medicine
David Chelmow
Affiliation:
Virginia Commonwealth School of Medicine
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Summary

Obstetric anal sphincter injuries (OASIS) are severe lacerations that extend into or through the anal sphincter complex. A thorough exam in the immediate postpartum period and familiarity with the anatomy is essential for the proper diagnosis and management. There is no difference in long-term complications regarding the use of an end-to-end anastomosis or overlapping technique to repair the external anal sphincter. It is reasonable to administer a single dose of a second-generation cephalosporin as antibiotic prophylaxis with third- and fourth-degree perineal lacerations. Proper postoperative care, including the avoidance of constipation, pelvic rest, good hygiene, pain control, and short-term follow-up visits, are key to avoiding complications.

Keywords

obstetric anal sphincter injuriesOASISthird-degree perineal lacerationfourth-degree perineal laceration
Type
Chapter
Information
Pregnancy Complications
A Case-Based Approach
 , pp. 171 - 173
Publisher: Cambridge University Press
Print publication year: 2025

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References

Committee on Practice Bulletins-Obstetrics. ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery. Obstet Gynecol. 2018;132(3):e87–e102.Google Scholar
Yeomans, E, Hoffman, B, Gilstrap, L, Cunningham, G (eds.). Cunningham and Gilstrap’s Operative Obstetrics, 3rd ed. New York: McGraw-Hill; 2017.Google Scholar
Groutz, A, Hasson, J, Wengier, A, et al. Third- and Fourth-Degree Perineal Tears: Prevalence and Risk Factors in the Third Millennium. Am J Obstet Gynecol. 2011;204:347.e1–347.e4.CrossRefGoogle ScholarPubMed
Royal College of Obstetricians and Gynaecologists. The Management of Third- and Fourth-Degree Perineal Tears: Green-top Guideline No. 29. London: Royal College of Obstetricians and Gynaecologists; 2015.Google Scholar
Hale, R, Ling, F. Episiotomy: Procedure and Repair Techniques, 1st ed. Washington, DC: American College of Obstetricians and Gynecologists; 2007.Google Scholar
Fernando, RJ, Sultan, AH, Kettle, C, Thakar, R. Methods of Repair for Obstetric Anal Sphincter Injury. Cochrane Database Syst Rev. 2013;(12):CD002866.CrossRefGoogle Scholar
Okeahialam, N, Wong, K, Thakar, R, et al. The Incidence of Wound Complications Following Primary Repair of Obstetric Anal Sphincter Injury: A Systematic Review and Meta-analysis. Am J Obstet Gynecol. 2022;227(2):182–191.CrossRefGoogle ScholarPubMed
Buppasiri, P, Lumbiganon, P, Thinkhamrop, J, Thinkhamrop, B. Antibiotic Prophylaxis for Third- and Fourth-Degree Perineal Tear during Vaginal Birth. Cochrane Database Syst Rev. 2014;(10):CD005125.CrossRefGoogle Scholar
Jha, S, Parker, V. Risk Factors for Recurrent Obstetric Anal Sphincter Injury (rOASI): A Systematic Review and Meta-analysis. Int Urogynecol J. 2016;27(6):849–857.Google ScholarPubMed

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