Diagnosing A Third Degree Tear

Third degrees tears must be diagnosed and repaired soon after childbirth. If there is a failure to do so, there could be a case of medical negligence. If this has happened to you, you should contact a legal expert to discuss your treatment as you could be entitled to make a claim.

Third degree tears

A third degree tear is a type of perineal injury sustained during the course of a vaginal delivery. It is not uncommon for such tears to occur during birth, although there are varying degrees of severity that can be defined as follows:-

First degree: laceration for the vaginal epithelium or perineal skin only;
Second degree: involvement of the perineal muscles but not the anal sphincter;
Third degree: disruption of the anal sphincter muscles which should be further subdivided into:
3a: less than 50% of external sphincter torn;
3b: more than 50% of external sphincter torn;
3c: internal sphincter also torn;
Fourth degree: a third degree tear with disruption of the anal epithelium.

A third degree tear is therefore a serious injury that must be identified and repaired soon after birth. This will ensure a woman has the best chance at making a full recovery.

How to diagnose a third degree tear

After all vaginal deliveries, the mother must undergo an examination to check whether or not she has suffered a perineal tear. According to NICE guidelines on intrapartum care, systemic assessment of genital trauma should include:-

Further explanation for the woman about what the healthcare professional plans to do and why;
Confirmation by the woman that tested effective local or regional analgesia is in place;
Visual assessment of the extent of perineal trauma to include the structure involve, the apex of the injury and assessment of bleeding;
A vaginal and rectal examination to assess whether there has been any damage to the perineal muscles, external or internal anal sphincter.

As long as this examination is carried out by a competent midwife or doctor, a third degree tear should be easily diagnosed. Healthcare professionals should remain particularly vigilant if there is a high degree of suspicion that a third degree tear has occurred – for example, if the baby is big, there was a prolonged labour or the delivery was complicated by shoulder dystocia.

Undiagnosed third degree tears

If, however, a genital trauma examination is not performed, it is probable that a third degree tear will go undiagnosed. This will lead to a whole host of bowel control problems for a woman including faecal urgency and incontinence. Although such complications can be improved with treatment such as sacral nerve stimulation and pelvic floor exercises, it is generally considered that a third degree tear must be repaired soon after the event. If there is a delay, the chances of a successful repair become less likely.

If this has happened to you, you need to speak to a medical negligence solicitor, as you may have been the victim of a substandard level of medical care. If so, you will be able to pursue compensation for the damage you have been caused.

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