June 10, 2022 Author : Leonor Santos Grade III or IV perineal tears is due to obstetric trauma and involves: Tissues of the vagina; Tissues of the perineum, that is, the region between the vagina and the anus; Structures around the anus. If the tear reaches the muscles around the anus, it is considered a grade III tear, if it involves the tissue of the anus, it is a grade IV tear. Perineal lacerations of this severity occur in 3%-4% of vaginal deliveries . How is a grade III or IV perineal tear treated Grade III and IV perineal lacerations are treated in the operating room and under epidural anesthesia (when there is no indication to the contrary), shortly after delivery . The placement of a urinary catheter is required to perform this treatment and the catheter is maintained until the anesthesia recovery is complete. The different layers of tissue affected by the laceration are reapproximated and sutured. The suture uses threads that are reabsorbed by the body, so it is not necessary to remove stitches . Antibiotic treatment is usually given during the procedure. Postoperative recovery Surgical treatment of grade III or IV perineal laceration requires hospitalization , which on average lasts 2 days. Antibiotic and laxative therapy is usually prescribed to be performed after discharge. Sometimes analgesic medication (for pain) is also needed. In the postpartum reassessment consultations , which takes place 4-6 weeks after delivery, the healing of the perineum is also evaluated. According to the indication given by the obstetrician, it may be important to make a physical medicine and rehabilitation consultation to determine the need for physical therapy to strengthen the pelvic floor. Long-term effects of a grade III or IV perineal tear About 80% of women who experience a grade III or IV perineal tear make a full recovery . A small number of women report difficulty with holding stools, urgency to defecate, anal incontinence for gas or stool. Most of these symptoms improve with physical therapy. What is the impact of perineal laceration on future deliveries? Anyone who has a grade III or IV perineal tear has a risk that it will recur in a future vaginal delivery of about 5%. In the absence of intestinal symptoms and if there has been a good healing, it is possible to have a vaginal delivery again. However, the mode of delivery after a grade III or IV perineal tear will always be discussed individually in each pregnancy . Sources International Urogynecologial Association. Third and fouth degredd perineal tears Meet the obstetrics-gynecology clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
