1. Perineal Laceration Repair
Cedar Rapids Medical Education Foundation
10/18/2010

2. Introduction One of the most common surgical procedure.
Potential sequelae:
1. Hemorrhage or hematoma.
2. Chronic perineal pain.
3. Dyspareunia
4. Urinary and fecal incontinence.

4. Perineal Anatomy
Perineal body
Blood supply
Nerve supply

6. Vaginal Hematoma

7. Perineal Laceration: Gradings
First degree
Second degree
Third degree
Fourth degree

8. Preparation
Suture: Polyglactin 3-0 less assoc. with perineal pain and wound dehiscence.
Anesthetic: 1% lidocaine, 10 cc syringe with 27 gauge 1.5 inch long needle.
Instruments: Needle driver, suture scissors, toothed forceps, allis clamps, deaver/gelpi retractor.
Strerile drapings/gloves/irrigation solution.

9. Preparation cont’d…… Good lighting and visualization.
Adequate analgesia.
General anesthesia or regional anesthesia for proper muscle relaxation or extensive tears.
Pudendal block

11. Management: Vaginal Laceration
May involve both sides of vaginal floor.
Anchor suture 1 cm above the apex.
Running stitch. Locking for hemostasis.
Should include vaginal mucosa and rectovaginal fascia.
Continue running suture upto hymenal ring.

12. Perineal Muscle Repair
Indicated in second through 4th degree tear.
Bulbocavernosus located immediately below the introitus.
Transverse perineal muscles located above the external anal sphincter.

13. Perineal Skin Repair Controversial: may assoc with perineal pain.
Indicated if skin not approximated.
Running subcuticular suture superior to interrupted transcutaneous suture.

14. Postpartum Care Sitz bath Ibuprofen
Stool softener in 3rd and 4th degree tear.

15. Prevention
Minimize episiotomy and forceps delivery.