Obstetrics is the branch of science that deals with the study of childbirth and the changes and complications associated with it. Obstetric injury refers to any injury that occurs in women either during childbirth or soon after delivery.
Obstetric injuries include perineal tears, also known as vaginal tears and perineal lacerations. These extend from the vagina into the perineum, the space between the anus and the vulva in the female. Other obstetrical injuries include genital tract haematoma, which involves accumulation of blood in the vagina or its outer part called the vulva.
What are the Causes of Perineal Tears/Obstetric Injuries?
Perineal tears/obstetric injuries are usually caused due to perineal trauma during vaginal birth as the baby stretches the vagina and the perineum during delivery. The other, less common causes include:
- Use of forceps for delivery
- Use of vacuum in which the suction from the cup damages the vaginal wall
What are the Different Types of Perineal Tears/Obstetric Injuries?
Based on the severity of the vaginal tear, they can be classified as:
- First-degree perineal tears: These are small tears affecting only the skin of the perineum. They usually heal within a few weeks and do not require treatment.
- Second-degree perineal tears: These tears affect the skin and the perineal muscles, but the anal sphincter remains unaffected. These usually require some stitches.
- Third- and fourth-degree perineal tears: These tears are deep and extend to the anal sphincter and even the rectum. They require surgical repair and treatment. They are also called obstetric anal sphincter injuries (OASIS). The anal sphincter is a group of muscles that regulate your bowel movements.
What are the Symptoms of Perineal Tears/Obstetric Injuries?
A woman who has suffered from colorectal/perineal obstetric injuries may experience:
- Perineal pain
- Stinging during urination
- Pain during intercourse
- Painful bowel movements
What are the Complications of Perineal Tears/Obstetric Injuries?
If left untreated, the vaginal tear may cause the following complications:
- Postpartum haemorrhage
- Loss of bowel control, i.e., faecal incontinence
- Recto-vaginal fistula
How are Perineal Tears/Obstetric Injuries Diagnosed?
After a vaginal delivery, your doctor will examine your genitals which include your vagina, perineum, and anus to look for bleeding and tears. Your doctor may insert a gloved finger inside the anus to assess the intensity of the tear.
You may also need to undergo an endoanal ultrasound. This involves the insertion of a probe inside the anus which generates internal images of the anal sphincter. This helps your doctor determine the severity of the perineal tear.
What is the Treatment for Perineal Tears/Obstetric Injuries?
Depending on the severity of the tear, your doctor will decide the appropriate treatment. Second-degree tears can be treated with stitches, but OASIS usually requires surgery. The area to be operated will be cleaned and sterilised using an antiseptic solution. You will be administered general anaesthesia and antibiotics to prevent infection. The tear will be sutured using resorbable sutures. After this, an antiseptic solution will be applied again.
Recovery and Post-Operative Care after Surgical Repair of Perineal Tears/Obstetric Injuries
You may be required to stay in the hospital for a day or two. During this time, your recovery is monitored.
- You will be given pain-relief medications, light and healthy diet, and your vital signs will be monitored.
- You will be discharged once your doctor is satisfied with your recovery and you can move around properly.
- Avoid rubbing the area after washing or bathing.
- Do not use shower gels or any other oils or creams on the wound.
- You should avoid heavy-duty work for a time after discharge.
- You should stay active through mild-intensity exercises such as walking and stretching.
What are the Risks and Complications of Surgical Repair of Perineal Tears/Obstetric Injuries?
As with any surgery, perineal tear repair may be associated with the following risks or complications:
- Swelling due to collection of blood or fluid at the surgical site
- Erythema or skin redness
- Injury to nearby tissues