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Third- and Fourth-degree Perineal Tears, Management (Green-top Guideline No. 29)

Published: 12/06/2015

This is the third edition of this guideline, which was previously published in July 2001 and March 2007 under the same title.

The reported rate of OASIS (in singleton, term, cephalic, vaginal first births) in England has tripled from 1.8% to 5.9% from 2000 to 2012. The overall incidence in the UK is 2.9% (range 0–8%), with an incidence of 6.1% in primiparae compared with 1.7% in multiparae. With increased awareness and training, there appears to be an increase in the detection of anal sphincter injuries. A trend towards an increasing incidence of third- or fourth-degree perineal tears does not necessarily indicate poor quality care. It may indicate, at least in the short term, an improved quality of care through better detection and reporting.

Obstetricians who are appropriately trained are more likely to provide a consistent, high standard of anal sphincter repair and contribute to reducing the extent of morbidity and litigation associated with anal sphincter injury.

A statement summarising any conflicts of interest for this guideline is available (PDF, 289.1 kb).

Patient information

Read the corresponding patient information on this topic which has also been published.

Elsewhere on the site

Consent advice for repair of perineal tears
Consent Advice No. 9 provides advice for clinicians on obtaining consent from women undergoing repair of third- or fourth-degree perineal repairs after childbirth