Perineal Tears : Types, Risk Factors

Perineal Tears

Perineal Tears are tears in the perineum. They usually occur in pregnant females over the age of 35 for the very first time. These females usually have rigid perineum or pelvic architecture, and therefore, they are at risk of perineal tears as the perineum suddenly expands during delivery.

Risk factors for Perineal Tears

• There could be excessive Perineal stretching due to a Large baby.
• Instrumental delivery could induce injury in cases of Shoulder Dystocia. In such cases, occipital delivery is preferred, or a Midline episiotomy is performed.
• Sudden stretching of the perineum is caused by Precipitated labor, which is Labor less than or equal to 3 hours.
• Perineal tears can also be seen with Breech delivery.
• The presence of a Rigid perineum can be due to Previous perineal scars/repairs, Elderly primigravida, or Vulvar pathology/edema.

In the cases where the risk factors of perineal tears are present, it becomes a clear Indication of Episiotomy. Episiotomy is a Surgical incision that is made to widen the vaginal introitus. The episiotomy incision is made to prevent the injury or tear of the vagina during delivery. 

The episiotomy incision is given in the second stage of labor. It helps in the easy and safe delivery of the fetus.

However, It is not given electively for all deliveries. This will increase the risk of rectal incontinence (Flatal and fecal incontinence)

Types of Perineal Tears

There are four types of perineal tears. These types help us categorize the tears so that proper management can be done. By dividing the perineal tears, we can also understand the prognosis.

Complete Perineal Tear 

Both type III and type IV perineal Tears are known as Complete perineal tears. 

Type III complete perineal tear, If it is diagnosed at the time of delivery, then it is repaired immediately. A Fresh cut is repaired immediately.

Type IV perineal tears are also repaired immediately, similar to type III perineal tears.

Presentation of Complete Perineal Tears

Fecal and flatal incontinence

Complications of Complete Perineal Tears

The area from the Vagina to the anus is colonized with bacteria of the colon.

Management Of Complete Perineal Tears

After 24 hrs, in a complete tear

• Wait until the cut ends are healed 
• Approximately 2.5 to 3 months
• Suture is made from the anal mucosa upwards 
• Anus suture type: Vicryl 30, monocryl
• Recommend low residue diet (First few days)

Frequently Asked Questions

Question: Which type of suture is synthetic absorbable and commonly used for episiotomy repair?

Answer: Vicryl suture is synthetic absorbable and commonly used for episiotomy repair.

Question: Which type of episiotomy has the least chance of causing complete perineal tears?

Answer: Mediolateral

Question: Which type of episiotomy is mostly avoided due to its risk of cutting the ducts of Bartholin’s gland?

Answer: Lateral

Question: What is the surgical procedure performed to widen the vaginal introitus during delivery to prevent injury or tears?

Answer: Episiotomy

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