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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.

Declaration of interests (guideline developers)

Dr RJ Fernando FRCOG, London: Mr Fernando has received speaker fees and travel grants from Astellas, AMS, Pfizer and Laborie unrelated to this topic.

Mr AH Sultan FRCOG, London: Mr Sultan has previously been a speaker for Astellas and Pfizer. He is the co-director of the Croydon perineal and anal sphincter trauma courses.

Professor RM Freeman FRCOG, Plymouth: Professor Freeman has received speaker fees from Astellas and Pfizer and has been on a European advisory board for Astellas. He has a patent/patents pending on Episcissors-60 as an inventor and is IUGA President.

Dr AA Williams MRCOG, Bolton: Dr Williams is on the Astellas and Femeda medical advisory board and has received sponsorship/honorarium for speaker meetings from Pfizer and Astellas.

Dr EJ Adams FRCOG, Liverpool: None declared.

Elsewhere on the site

Patient information on 3rd/4th-degree perineal tears
Our patient information on this topic is specifcially written for women, their partners and the public
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
Patient information

Patient information

Information about third- and fourth-degree tears during childbirth

Information hub on perineal tears and episiotomies

Advice on types of tears, reducing risk, and helping recovery