Complete perineotomy

Factors associated with the occurrence of perineal lacerations

“…Obstetrical textbooks began to advocate episiotomies not only because they were easier to repair than ragged lacerations but because they would obviate tears into the rectum. A new trend developed during the 1950s of purposefully extending an episiotomy into the rectum when a fourth‐degree laceration seemed probable—the “intentional fourth degree” or “complete perineotomy.” Several investigators reported series of deliveries where this procedure was used, documenting occurrence of about 10% complete perineotomies 15,16,17 . There was controversy over this practice, and several physicians reported studies with much lower rates of fourth‐degree lacerations using more traditional management.…”