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3rd and 4th Degree Perineal Tear

3rd and 4th Degree Perineal Tear

There are different types of perineal tear, with 3rd and 4th degree tears being the most severe.

3rd degree perineal tear

A 3rd degree tear can be classified as follows:

  • A laceration of the vaginal epithelium, perineal skin, perineal body and anal sphincter(s).

A 3rd degree tear is different to other types of perineal tear because it can be subdivided into a further three categories. This allows clinicians to better define the exact structures that have been injured. They are as follows:

  • 3a: partial tear of the external sphincter involving less than 50% thickness
  • 3b: tear of the external sphincter involving more than 50% thickness
  • 3c: external and internal sphincter torn

A 3rd degree tear has to be diagnosed not long after the birth. It must then be repaired with dissolvable stitches. The repair must take place in an operating theatre and must be carried out by a surgeon with the necessary experience. Afterwards a digital rectal examination should be done to ensure the full length of the tear has been repaired.

4th degree perineal tear

A 4th degree tear can be classified as follows:

  • A laceration of the vaginal epithelium, perineal skin, perineal body, anal sphincters and the anal mucosa (the lining of the anal canal).

Just like a 3rd degree tear, a 4th degree tear must be quickly diagnosed and repaired in theatre. Repairing a 4th degree tear is a complex procedure, so it is vital the surgeon has the expertise required. Again, a digital rectal examination after the repair will guarantee that the entire defect has been stitched.

3rd and 4th degree perineal tear medical negligence

3rd and 4th degree perineal tears are nasty injuries but they are not necessarily negligent. They are uncommon but accepted risks of childbirth.

However, it is true that 3rd and 4th degree tears do have a high medico-legal profile. This is because the injuries are sometimes missed by medical practitioners, or they are poorly repaired. When this happens the patient can be left with a very poor outcome, causing her to develop faecal incontinence and urgency.

Has this happened to you?

If you have had a very poor outcome after a 3rd or 4th degree tear, you need to consider whether medical negligence is to blame. Examples of medical negligence include failing to diagnose the tear, failing to diagnose the correct type of tear, and failing to perform an adequate repair.

To find out if you are entitled to compensation for medical negligence, please get in touch with us today.

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