Vaginal Lacerations

The perineum and anus become stretched and thin, which results in increased risk of spontaneous laceration and anterior tears involving the urethra and labia.

FIGURE 6-10. Delivery of posterior shoulder.

(Reproduced, with permission, from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis & Treatment. Nor-walk, CT: Appleton & Lange, 1994:212.)

FIGURE 6-10. Delivery of posterior shoulder.

(Reproduced, with permission, from DeCherney AH, Pernoll ML. Current Obstetric & Gynecologic Diagnosis & Treatment. Nor-walk, CT: Appleton & Lange, 1994:212.)

First Degree

Involve the fourchette, perineal skin, and vaginal mucosa, but not the underlying fascia and muscle

Repair: Absorbable sutures (e.g., 3-0 vicryl) Second Degree

First degree plus the fascia and muscle of the perineal body but not the rectal sphincter

Repair: Done in layers, sometimes using a crown stitch to bring the perineal body together (e.g., with 3-0 vicryl)

Third Degree

Second degree plus involvement of the anal sphincter

Repair: Repair anal sphincter with interrupted sutures (e.g., 2-0 vicryl) and repair vagina as in second-degree laceration.

Fourth Degree

Extend through the rectal mucosa to expose the lumen of the rectum

Repair: Same as third-degree repair plus careful repair of anal mucosa (e.g., with 4-0 vicryl)

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