Managing Complications in Pregnancy and Childbirth: - IAWG

P-88 Repair of vaginal and perineal tears• If the sphincter is torn:- Grasp each end of the sphincter with an Allis clamp (thesphincter retracts when torn). The sphincter is strong and willnot tear when pulling with the clamp (Fig P-51, page P-88);- Repair the sphincter with two or three interrupted stitches of 2-0 suture.FIGURE P-51Suturing the anal sphincter• Apply antiseptic solution to the area again.• Examine the anus with a gloved finger to ensure the correct repairof the rectum and sphincter. Then change to clean, high-leveldisinfected gloves.• Repair the vaginal mucosa, perineal muscles and skin (page P-84).POST-PROCEDURE CARE• If there is a fourth degree tear, give a single dose of prophylacticantibiotics (page C-35):- ampicillin 500 mg by mouth;- PLUS metronidazole 400 mg by mouth.• Follow up closely for signs of wound infection.• Avoid giving enemas or rectal examinations for 2 weeks.• Give stool softener by mouth for 1 week, if possible.