Prevention and Management of Obstetric Lacerations at Vaginal Delivery

Publication Date: September 1, 2018
Last Updated: March 14, 2022

Recommendations

Because application of warm perineal compresses during pushing reduces the incidence of third-degree and fourth-degree lacerations, obstetrician–gynecologists and other obstetric care providers can apply warm compresses to the perineum during pushing to reduce the risk of perineal trauma. (A)
574
Restrictive episiotomy use is recommended over routine episiotomy. (A)
574
For full-thickness external anal sphincter lacerations, end-to-end repair or overlap repair is acceptable. (A)
574
A single dose of antibiotic at the time of repair is reasonable in the setting of obstetric anal sphincter injuries. (B)
574
Perineal massage during the second stage of labor may help reduce third-degree and fourth-degree lacerations. (B)
574
If there is need for episiotomy, mediolateral episiotomy may be preferred over midline episiotomy because of the association of midline episiotomy with increased risk of injury to the anal sphincter complex. However, limited data suggest mediolateral episiotomy may be associated with an increased likelihood of perineal pain and dyspareunia. (B)
574
Either standard suture or adhesive glue may be used to repair a hemostatic first-degree laceration or the perineal skin of a second-degree laceration. (B)
574
Continuous suturing of a second-degree laceration is preferred over interrupted suturing. (B)
574
Stool softeners and oral laxatives should be prescribed to women who sustain OASIS, and counseling postpartum should include discussing ways to avoid constipation. (C)
574
Women who have a history of OASIS should be counseled that the absolute risk of a recurrent OASIS is low with a subsequent vaginal delivery; however, it is reasonable to perform a cesarean delivery based on patient request after advising of the associated risks. (C)
574
If the internal anal sphincter can be adequately identified, repair has been recommended either as a part of the distal portion of the reinforcing second layer of the rectal muscularis using a 3-0 polyglactin suture or separately from the external anal sphincter using a 3-0 monofilament polydioxanone suture. (C)
574

Recommendation Grading

Overview

Title

Prevention and Management of Obstetric Lacerations at Vaginal Delivery

Authoring Organization

Publication Month/Year

September 1, 2018

Last Updated Month/Year

January 5, 2023

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Inclusion Criteria

Female, Adolescent, Adult

Health Care Settings

Hospital

Intended Users

Physician, nurse midwife, nurse, nurse practitioner, physician assistant

Scope

Assessment and screening, Prevention, Management

Diseases/Conditions (MeSH)

D022125 - Lacerations, D036861 - Delivery, Obstetric

Keywords

lacerations, perineal lacerations, vaginal lacerations