Managing Complications in Pregnancy and Childbirth: - IAWG

P-86 Repair of vaginal and perineal tearsFIGURE P-49Repairing the skinREPAIR OF THIRD AND FOURTH DEGREE PERINEAL TEARSNote: The woman may suffer loss of control over bowel movements andgas if a torn anal sphincter is not repaired correctly. If a tear in therectum is not repaired, the woman can suffer from infection andrectovaginal fistula (passage of stool through the vagina).Repair the tear in the operating room.• Review general care principles (page C-17).• Provide emotional support and encouragement. Use a pudendalblock (page P-3) or ketamine (page P-13). Rarely, if all edges of thetear can be seen, the repair can be done using local infiltration withlignocaine (see above) and pethidine and diazepam IV slowly (donot mix in the same syringe).• Ask an assistant to massage the uterus and provide fundalpressure.• Examine the vagina, cervix, perineum and rectum.• To see if the anal sphincter is torn:- Place a gloved finger in the anus and lift slightly;- Identify the sphincter, or lack of it;- Feel the surface of the rectum and look carefully for a tear.• Change to clean, high-level disinfected gloves.