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. 2005 Aug;193(2):530-4; discussion 534-6.
doi: 10.1016/j.ajog.2005.03.045.

Differences in outcomes after third- versus fourth-degree perineal laceration repair: a prospective study

Catherine M Nichols  1 , Elizabeth H Lamb, Viswanathan Ramakrishnan
Affiliations

Differences in outcomes after third- versus fourth-degree perineal laceration repair: a prospective study

Catherine M Nichols et al. Am J Obstet Gynecol. 2005 Aug.

Abstract

Objective: The purpose of this study was to compare outcomes after third- versus fourth-degree laceration repair.

Study design: Fifty-six primiparous women who sustained a third- or fourth-degree tear were enrolled at delivery and demographic and obstetric data were collected. At 6 weeks' postpartum, subjects completed a bowel function questionnaire and endoanal ultrasonography was performed. Fisher exact test and chi-square were used for statistical analysis.

Results: Thirty-nine women with third- and 17 with fourth-degree tears were enrolled. Subjects with fourth- were more likely to report bowel symptoms (59% vs 28%, P = .03), and to demonstrate persistent combined defects of the internal (IAS) and external anal sphincter (EAS) (48% vs 8%, P = .002) than third-degree tears. Combined defects were associated with the highest risk of bowel symptoms (OR 18.7, 95% CI 3-101, P < .001).

Conclusion: Bowel symptoms were more common after fourth- than third-degree repair, and may be secondary to higher rates of combined defects of the IAS and EAS.

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