At the perineal review, check for pain out of proportion, discharge, wound gaping and fever. Women with a long active second stage, a deep tear or a repair that needed a doctor are the ones in whom breakdown was commonest in the Danish REPAIR cohort. Bring them back earlier rather than leaving them to the routine postnatal check, and ask them to report worsening pain or discharge rather than wait.
- Record second-stage duration and tear depth in the repair note so the postnatal team can see risk at a glance.
- Offer an earlier perineal check to women with a prolonged active second stage or a deep tear.
- Give every woman clear signs to report: rising pain, offensive discharge, wound opening, fever.
- Examine the wound rather than accepting reassurance by phone when symptoms are reported.
Why it matters
Wound breakdown after second-degree tears is common enough to plan for, not an afterthought.
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