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

Published: 01/03/2007

Update November 2014: This guideline is currently being revised, with publication anticipated mid 2015. The version available on the website and app will remain valid until replaced.

This is the second edition of this guideline, which was originally published in July 2001 under the same title.

The overall risk of obstetric anal sphincter injury is 1% of all vaginal deliveries. With increased awareness and training, there appears to be an increase in detection of anal sphincter injury. 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.

Obstetric anal sphincter injury encompasses both third- and fourth-degree perineal tears:

  • A third-degree perineal tear is defined as a partial or complete disruption of the anal sphincter muscles, which may involve either or both the external (EAS) and internal anal sphincter (IAS) muscles
  • A fourth-degree tear is defined as a disruption of the anal sphincter muscles with a breach of the rectal mucosa

The purpose of this guideline is to provide evidence-based guidance on the diagnosis, management and treatment of third- and fourth-degree perineal tears.

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