Sphincter injuries are common after instrumental delivery and are missed when the perineum is only inspected. A systematic examination before repair, including a rectal examination, is what finds the third-degree tear that looks like a second-degree one.
Classify what you find, repair in good light with adequate analgesia, and document the grade. Women with a sphincter injury need antibiotics, laxatives and planned follow-up for continence, and the injury shapes advice about the next birth.
- Do a rectal examination before repairing any tear after an instrumental birth.
- Grade the tear and write the grade in the notes.
- Repair sphincter injuries in theatre or with equivalent light, analgesia and an experienced operator.
- Arrange follow-up for bowel control, and ask about it directly; few women volunteer it.
Why it matters
With one in five operative births involving a sphincter injury, a missed tear is a common and lasting harm.
Read the rest in the app
You have read your two free briefings this month. The app carries all 27 specialties, every morning, free — and this finding is waiting in it.
Scan to keep reading on your phone. No account needed to start.
Tomorrow morning, before your first patient
One edition a day for obstetrics & gynaecology, written by the desk, every claim tied to its paper. Six minutes.
Get the app — free