Guidelines for the management of third and fourth degree perineal tears after vaginal birth from the Austrian Urogynecology Working Group

Abstract

The purpose of this guideline is to provide a decision aid for diagnosis, treatment, and follow-up of patients with major perineal tears and thus minimize the risk of persistent symptoms. In 2007, the "Guideline for the management of third and fourth degree perineal tears after vaginal birth" was established by members of the Austrian Urogynecologic Working Group (AUB). The guideline was updated in 2011, including literature published up to 30 November 2011. The DELPHI method was used to reach consensus. Evidence-based and consensus-based statements were defined for epidemiology, risk factors, classification, diagnosis, surgery, and follow-up of major perineal lacerations at vaginal birth.

Perineal tears – A review

“…More than 85% of females who undergo a vaginal birth will suffer from some degree of perineal tear, 2 with 0.6-11% of all vaginal deliveries resulting in a third-degree or fourth-degree tear. [5][6][7] Fortunately, the incidence of perineal tears decreases with subsequent births, from 90.4% in women who are nulliparous to 68.8% in women who are multiparous undergoing vaginal deliveries. 4…”

“…The risks can be best separated into the following subgroups: maternal, fetal and intrapartum risk factors (Box 2). 4,[7][8][9][10][11][12][13][14][15][16]…”

“…This examination should include a digital rectal examination to evaluate the tone of the anal sphincter. 7 From here, the midwife or obstetrician can decide if conservative or surgical management is required.…”

“…Regardless of the severity of the tear, the following principles should be applied during the repair: 7,25 • The repair should be completed by an experienced clinician, ideally one trained in obstetrics.…”

“…These tears should be repaired as soon as possible in an operating theatre, using regional or general anaesthesia, to achieve anal sphincter relaxation. 7,25 The obstetric anal sphincter injuries repair should be performed by trained practitioners, as inexperienced attempts can lead to anal incontinence. 25 correspondence ajgp@racgp.org.au…”