![]() ![]() There is also a risk of infection and wound break down with any vaginal repair. However, hematoma formation can lead to large amounts of blood loss in a very short time.īeyond bleeding, immediate complications also include pain and suturing time leading to delayed mother-child bonding. Most bleeding can be quickly controlled with pressure and surgical repair. The most common complication of a perineal laceration is bleeding. Ĭare after any perineal laceration repair, but especially after an OASIS injury, should include pain management, laxatives or stool softeners to avoid constipation and monitoring for signs of urinary retention. Ī single dose of a second-generation cephalosporin can be given after any OASIS repair to decrease the patient’s risk of infection and wound breakdown. Once the rectal mucosa and anal sphincter are repaired, the remaining portion of the laceration is closed in the same fashion as a second-degree tear. ![]() The internal anal sphincter should be repaired separately from the external anal sphincter when possible. The anal sphincter is then reapproximated with attention paid to include the fascial sheath of the muscle with the repair. Care is taken to not penetrate through the rectal mucosa. In a fourth-degree laceration, the rectal mucosa is reapproximated starting at 1 cm above the apex of the laceration. ![]() Third- and fourth-degree lacerations are repaired in a stepwise fashion. After these areas are properly closed, the skin is reapproximated. Once the hymen is restored attention is turned to the perineal body and submucosal region. Suture is used to reapproximate the vaginal mucosa to the level of the hymen. When repairing second-degree lacerations, continuous or running suture should be used over interrupted suturing to decrease post-partum pain and the possibility of the patient requiring suture removal. It can be left to the surgeon’s discretion to use suture or adhesive for hemostatic first-degree lacerations. A trial comparing skin adhesive and suture for first degree lacerations found that the total repair time was shorter and overall patient pain scores were lower in the adhesive group. If repair is desired, suture or adhesive skin glue can be used if the laceration is hemostatic. First degree lacerations that are hemostatic and do not distort the natural anatomy do not need to be repaired. Most perineal lacerations are sutured, but there is limited evidence to support this practice for first and second-degree lacerations. ![]() Both the World Health Organization and the American College of Obstetrics and Gynecologists recommended restricted use of episiotomy. There is insufficient evidence to support the routine use of episiotomy. The mediolateral episiotomy is more difficult to repair and is associated with increased post-partum pain and blood loss. The midline episiotomy is the most commonly performed in the United States and is associated with a higher frequency of severe perineal lacerations. The two most common types of episiotomies are midline and mediolateral. An episiotomy may be indicated if there is a need for expedited delivery of the fetus, soft tissue dystocia, or a need to aid an operative vaginal delivery. This is done just prior to delivery to decrease maternal blood loss. The most common risk factors for OASIS injuries are forceps or vacuum deliveries, a midline episiotomy, and/or a large fetus.Īn episiotomy is a surgical procedure performed at the bedside during the second stage of labor which causes enlargement of the posterior vagina. Malpresentation, including persistent occiput posterior position and advancing gestational age, both contribute to perineal lacerations. Risk factors for perineal lacerations include nulliparity, operative vaginal delivery, midline episiotomy, Asian race, and increased fetal weight. ![]()
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