Managing Complications in Pregnancy and Childbirth: - IAWG

REPAIR OF VAGINAL AND PERINEAL TEARS P-83There are four degrees of tears that can occur during delivery:• First degree tears involve the vaginal mucosa and connectivetissue.• Second degree tears involve the vaginal mucosa, connective tissueand underlying muscles.• Third degree tears involve complete transection of the analsphincter.• Fourth degree tears involve the rectal mucosa.Note: It is important that absorbable sutures be used for closure.Polyglycolic sutures are preferred over chromic catgut for theirtensile strength, non-allergenic properties and lower probabilityof infectious complications. Chromic catgut is an acceptablealternative, but is not ideal.REPAIR OF FIRST AND SECOND DEGREE TEARSMost first degree tears close spontaneously without sutures.• Review general care principles (page C-17).• Provide emotional support and encouragement. Use localinfiltration with lignocaine (page C-38). If necessary, use apudendal block (page P-3).• Ask an assistant to massage the uterus and provide fundalpressure.• Carefully examine the vagina, perineum and cervix (Fig P-46, pageP-84).• If the tear is long and deep through the perineum, inspect to besure there is no third or fourth degree tear:- Place a gloved finger in the anus;- Gently lift the finger and identify the sphincter;- Feel for the tone or tightness of the sphincter.• Change to clean, high-level disinfected gloves.• If the sphincter is injured, see the section on repair of third andfourth degree tears (page P-86).