Natural (spontaneous) Perineal tear

“Episiotomy compared with those after spontaneous perineal laceration ,..We found a significantly higher infection rate and a longer healing period in the episiotomy group”… “The results indicate that many women will unnecessarily suffer after an episiotomy”

(Department of Obstetrics and Gynecology, Central Hospital,Skövde, Sweden)

A first-degree laceration or superficial tear

often so small that few or no stitches are required. (but surgical repair will help in early healing and maintain the proper anatomy of the vagina)

heal spontaneously  (w/in few weeks)

cause little or no discomfort.

Second degree laceration Involves rupture of the

muscles of the perineum with deep tears in the vaginal wall

Should be immediately repaired (stiches),  preferably as soon as the baby and the placenta has been delivered, or at least within the first 24 hours

It will cause some discomfort take a few weeks to heal

The stitches dissolve on their own during the healing period

Third degree laceration Extends from the vaginal opening

through the posterior vaginal wall and the perineal muscles upto the anus with injuries to the external anal sphincter \

Anal or the rectal canal may or may not be involved.

Must always be repaired  surgically under anesthesia

Can cause considerable pain for many months and increases your risk of anal incontinence

Fourth-degree tear complete perineal tear. the vaginal tissue, perineal skin, and

perineal muscles that extends into the anal sphincter both external and internal as well as the rectal mucosa are torn

Third and fourth degree tears are more likely to be associated with complications, including infection, bleeding, anal incontinence, and increased pain

Urinating or having a bowel movement can be painful

Repaired surgically under anaesthesia in operation theatre

If symptoms associated with tear still presence, pt may be offered a caesarean section for next delivery to reduce the risk of further problems

In General… Spontaneous tear recover in the same or less time and often with

fewer complications than those who had an episiotomy

Most 3rd and 4th degree tears will heal in time but might experiences

Inability to control flatulence (breaking wind) Problems with your bowels including leakage, urgency and lack of

control Pain and soreness in the perineum Haemorrhoids Apprehensive towards sex Concerned about future deliveries Fistula (connection) between the anus and the vagina after the

repair has healed. This is uncommon and can be repaired by further surgery

Although episiotomy is an important risk factor for severe lacerations after vaginal delivery, there are other significant independent risk factors, such as maternal age, birth weight, and assisted vaginal delivery, that should be considered

(Angioli,Gomez,Cantuaria,O’ssulivian,2000)

Refrences Baby center.(2013).Perineal tears .Retrieved from :

http://www.babycenter.com/0_perineal-tears_1451354.bc?page=2 Linjen,J.(2012). Types of Spontaneous Vaginal Tears.Retrieved from:

http://www.healthline.com/health/pregnancy/cervical-vaginal-tears Baby center .(2011).Episiotomy.Retrieved From

http://www.babycenter.com/0_episiotomy_165.bc#articlesection2 Northern Lincolnshire & Goole Hospitals NHS Foundation Trust(2010).Perineal

tears. Retrieved From http://www.nlg.nhs.uk/IfP/single/IFP-0559.pdf Nursing Standard .(2007). Perineal tears and episiotomy Retrieved from:

http://nursingstandard.rcnpublishing.co.uk/archive/article-perineal-tears-and-episiotomy

Mazumdar,M.D.(n.d).Perineal tear after childbirth .Retrieved From:http://www.gynaeonline.com/perineal_tear.htm

Larsson ,P.G., Platz-Christensen,J.J., Bergman,B.,& Wallstersson ,G.(1991) Advantage or disadvantage of episiotomy compared with spontaneous perineal laceration.Retrieved From :http://www.ncbi.nlm.nih.gov/pubmed/1885090

Angioli ,R., Gómez-Marín, O., Cantuaria, G.,& O'sullivan ,M.J. Severe perineal lacerations during vaginal delivery: the University of Miami experience .Retrieved From :http://www.ncbi.nlm.nih.gov/pubmed/10819834