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Whats the difference between 3rd and 4th Degree Perineal Tears?

What's the difference between 3rd and 4th Degree Perineal Tears?

Perineal tears can occur naturally during the vaginal delivery of a baby. There are different types of perineal tear, with 3rd and 4th degree tears being the most severe. Fortunately, only approximately 3 in 100 women will experience these types of perineal tear. This article will explain the differences between 3rd and 4th degree perineal tears.

What is a perineal tear?

A natural birth will cause the vagina to stretch as the baby passes through the vaginal opening and this may result in the tearing of the skin between the vagina and the back passage (the anus). This area is called the perineum. Perineal tears vary in severity. A 1st degree tear which may be only skin-deep is likely to heal naturally. A 2nd degree tear which also affects the muscle of the perineum may need stitches. However, 3rd and 4th degree tears are more serious and require prompt and skilled attention.

What is a 3rd degree perineal tear?

A third degree tear is classified as involving the laceration (tearing) of the following:

  • the vaginal epithelium (the tissue lining the vagina)
  • the perineal skin
  • the perineal body, and
  • the anal sphincter (the muscle that controls the anus).

A 3rd degree tear can be subdivided into a further three categories. This allows for clearer definition of the extent of the injuries. These categories 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.

What is a 4th degree perineal tear?

In addition to the damage of a 3rd degree tear, a 4th degree tear also extends into the lining of the anus. Therefore, it is classified as causing laceration or tearing of:

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

How should perineal tears be treated?

Third and fourth degree perineal tears should be diagnosed as soon as possible after the birth. They must then be repaired in an operating theatre under a local or general anaesthetic and the repair 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 properly repaired.

After the repair, the patient may need a catheter until she is able to walk to the toilet. Pain relief will also be necessary.

Medical Negligence claims for missed perineal tears

Unfortunately, perineal tears can sometimes be missed or inadequately repaired, leading to a distressing outcome for the new mother, possibly resulting in incontinence. When this occurs, the patient may be entitled to make a claim for medical negligence.

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