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(Laceration, Vaginal; Vaginal Tears; Tears, Vaginal)
- First—superficial lacerations of the skin or vagina; often no repair is needed.
- Second—deep laceration involving the skin or vagina and underlying fatty tissue; a simple suture repair is needed.
- Third—deeper laceration involving the muscles of the anus (sphincter); suture repair of the muscle and the vagina is needed.
- Fourth—most extensive laceration involving the entire thickness of the vagina, sphincter, and through the inner lining of the rectum (rectal mucosa); suture repair of the vagina, muscle, and rectal mucosa is needed.
- Delivering a baby whose head is too large to easily fit through the vaginal opening
- Going into labor too quickly (without giving the perineum time to stretch)
- Having a difficult vaginal delivery and needing assistance with forceps or vacuum extraction
- Having a very large baby
- Having a baby for the first time
- Having had lacerations in prior pregnancy
|Stitches to Repair Third Degree Tear|
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- Nonsteroidal anti-inflammatory drugs (eg, ibuprofen )
- Warm baths—Sitting in a warm bath that only covers your hips and buttocks can sometimes help; this is called a sitz bath.
- Ice or witch hazel pads—Ice wrapped in a cloth or chilled witch hazel pads applied to the area are sometimes used to dull the pain.
- Perineal massage—You or your partner can begin to massage the perineum with fingers and a lubricating jelly, like K-Y Jelly, when you are about 34 weeks pregnant. After that, it should be done every day. This action will soften and smooth the skin and may help it to stretch more easily during labor.
- Kegel exercises —Contract and hold the muscles of your pelvic floor. These are the same muscles you use to stop the flow of urine. Practice contracting, holding, and slowly releasing these muscles to strengthen them.
- Practice good nutrition—Healthy skin stretches more easily.
- A slow second stage of labor—Controlled pushing allows the perineum to stretch slowly.
The American Congress of Obstetricians and Gynecologists http://www.acog.org/
Women's Health.gov http://www.4woman.org/
Health Canada http://www.hc-sc.gc.ca/
Women's Health Matters http://www.womenshealthmatters.ca/
Clinical management guidelines for ostetrician: gynecologists. ACOG Practice Bulletin. 2000;17.
Leeman L, Sprearman M, Rogers R. Repair of obstetric perineal lacerations. Am Fam Physician. 2003;68(8):1585-1590.
Perineal massage in pregnancy. American College of Nurse-Midwives website. Available at: http://www.midwife.org/ACNM/files/ccLibraryFiles/Filename/000000000656/Perineal%20Massage%20in%20Pregnancy.pdf. Accessed August 9, 2012.
- Reviewer: Andrea Chisholm, MD
- Review Date: 09/2013
- Update Date: 09/30/2013