A rupture of the perineum is an injury that often occurs in childbirth. A rupture of the perineum can cause serious complications, depending on the severity of the rupture. Check what effects can a perineal rupture have and how to prevent it? See also what is the classification of perineal fracture.
Contents:
- Crotch rupture - risk factors
- Crotch fracture - classification
- Crotch fracture - complications
- Crotch fracture - prevention
- Crotch incision - indications
- Crotch incision - complications
A rupture of the perineumis one of the most frequent and serious injuries that occurduring childbirth . Perineal tears can occur in up to 80% of vaginal births. The rupture typically affects the perineum and vagina, but can also affect the labia, clitoris, urethra, and even the cervix.
Some of the injuries that occur in childbirth heal on their own, while others require stitches.
The severity of a perineal tear varies from rupture of the skin and superficial structures of the perineum to heavier tears that can damage the muscles of the anal-rectal sphincter complex. It is worth mentioning here that minor cracks are not required to be repaired as they do not bleed or disturb anatomical relations.
Crotch rupture - risk factors
Risk factors for severe perineal rupture include:
- surgical delivery (using forceps or a vacuum)
- midline perineal incision
- higher birth weight of the child
- labor induction and stimulation
- Asian origin of the patient
- epidural anesthesia
- persistent occipital posterior position
- childbirth
Crotch fracture - classification
Crotch Fracture Classification
| DEGREE | DEFINITION |
| I | Tearing only the vaginal epithelium or skin around the perineum |
| II | Involvement of the perineal muscles, but not the anal sphincter |
| III | Injury to the anal sphincter |
| IIIa | Tear<50% grubości zwieracza zewnętrznego odbytu |
| IIIb | Tear>50% of the thickness of the external anal sphincter |
| IIIc | Tear also internal anal sphincter |
| IV | Damage to the anal epithelium |
Crotch fracture - complications
Determining the extent of a perineal tear during delivery is of particular importance for repair planning and postpartum counseling. It happens that, despite the proper repair of the perineum, complications occur.
The most common complications associated with a perineal injury during childbirth include:
- fecal incontinence
- rectovaginal (perineal-perineal) fistula
- postpartum genital hematomas
- infection and dehiscence of the perineal wound
- necrotizing fasciitis
- puerperal urinary incontinence
- dyspareunia
- stress urinary incontinence
- pelvic organ prolapse
- unintentionally leaving a foreign body
Crotch fracture - prevention
In order to protect the perineum from rupture and reduce the possibility of brain injury in a newborn child, an episiotomy is performed (the so-calledepisiotomy ). It should be made in the second stage of labor when you notice the paling of the perineal skin, which precedes its fracture.
Premature perineal incision is more painful and involves more blood loss. On the other hand, a properly made perineal incision clearly reduces the resistance of the pelvic floor tissues during the birth of the baby's head.
It is also worth mentioning that with a planned perineal incision it is possible to perform anesthesia - either locally or through a blockade of the vulvar nerve.
Crotch incision - indications
There are the following indications for the perineal incision:
- threat to the life of the fetus
- maternal discomfort during the delivery of the fetal head
- risk of perineal tear if it is not compliant (especially observed in older women giving birth for the first time)
- immature fetus birth
- bending position of the fetal head
- multiple pregnancy
- surgical delivery (forceps operation, vacuum lifter, manual support in the pelvic position of the fetus)
Crotch incision - complications
The perineal incision, like any procedure, may be associated with complications - both early and late.
Early complications of an episiotomy include pain, bleeding, hematomas, infection, and wall damagevagina, anal and rectal sphincter.
Late complications include dyspareunia, stress urinary and fecal incontinence, rectovaginal fistulas or scar endometriosis.