Post Date July, 23 2023
Perineal laceration is a common obstetric injury during childbirth, which can be divided into four levels based on the degree of injury. While paying attention to the impact on the patient, it is also important to protect the perineum.
Perineal laceration grading
1 degree perineal laceration: Mild perineal laceration, perineal epidermal surgery, seamless self recovery, common in second delivery mothers.
Degree 2 perineal laceration: moderate perineal laceration, the depth of laceration reaches subcutaneous soft tissue and muscle, but does not damage the anal muscles. This is the grading of lacerations that many mothers experience, which can be easily repaired without leaving any sequelae.
Degree 3 perineal laceration: severe perineal laceration, subcutaneous soft tissue injury, anal Sphincter rupture, and untimely suture may cause postpartum infection.
Degree 4 perineal laceration: severe perineal laceration, mainly characterized by laceration of anal Sphincter and rectal mucosa.
Clinical manifestations of perineal laceration
Third degree or complete perineal laceration, including Vaginal orifice laceration, perineal laceration and anal sphincter laceration. In severe cases, the laceration can extend to the rectal wall, causing fecal and gas incontinence. Due to improper handling during childbirth, there may be occasional injuries. Due to the strong promotion of the new law of midwifery, midwives have appropriately protected the perineum, greatly reducing the incidence of third degree perineal laceration. Occasionally, it also occurs in large hospitals in cities.
Third degree perineal laceration occurs in the second stage of labor, and during the coronation of the fetal head, the midwife may perceive a tearing sensation in the perineum. Immediately after delivery, a third degree laceration was discovered and sutured. Due to the different degree of rupture, the symptoms are also very important. If only a part of the Sphincter is ruptured, it will be impossible to control when the stool is loose, and the false courtesy cannot be controlled. In this situation, the patient should try to dry their stool as much as possible. The control of stool mainly depends on the anal Sphincter. When the abdominal pressure increases, the stool will not overflow suddenly, but the autonomous control of stool response depends not only on the Sphincter, but also on the anal levator. In severe cases, even if the stool is dry, one cannot control oneself, and the external genitalia is often contaminated by the stool.
During the examination, the perineum disappears and the vagina communicates with the end of the rectum. The skin behind the anus shows radial wrinkles, and the broken end of the Sphincter shrinks to form a small depression on both sides of the anus. Anal examination can make the patient contract inward to test the control function of Sphincter. If there is also a tear in the rectum, the rectal mucosa appears red and protrudes outward.
