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Undetected Perineal Tears

Undetected Perineal Tears

Perineal tears are, unfortunately, a common factor of vaginal delivery. For the most part, these injuries are quickly recognised and effectively managed. However, there are cases in which a woman is discharged from hospital without having her tear correctly diagnosed and treated, an event which quickly leads to the onset of serious complications.

Perineal Tears

A perineal tear is an injury sustained during vaginal delivery. This may be a minor incident involving superficial damage to the perineal skin, or it may be more serious rupture extending to the sphincter muscles. The differing severities of a perineal tear can be categorised as follows:-

  • First degree tear: laceration of the vaginal epithelium or perineal skin only;
  • Second degree tear: involvement of the vaginal epithelium, perineal skin, perineal muscles and fascia but not the anal sphincter;
  • Third degree tear: disruption of the vaginal epithelium, perineal skin, perineal body and anal sphincter muscles. This can be further subdivided into:
    • 3a: partial tear of the external sphincter involving less than 50% thickness
    • 3b: tear of the external sphincter involving more than 50% thickness
    • 3c: external and internal sphincter torn;
  • Fourth degree tear: The same as a third degree tear, but the injury extends to the disruption of the anal epithelium.

Diagnosing A Perineal Tear

According to NICE guidelines, there should be a systematic assessment of women for genital trauma soon after they have given birth. This should begin with the provision of effective pain relief before the genital area is visually examined. If there is any suspicion at all that damage has been sustained to the external or internal anal sphincter, then medical staff should promptly seek consent to carry out a rectal examination.

Additionally, if a woman has experienced factors that are known to increase the chance of tearing, then extra vigilance should be taken during the intrapartum examination. These risks include: a prolonged labour, a larger than average baby, a forceps delivery, a first-time mother, and shoulder dystocia (where the baby's shoulder gets stuck behind the mother's pubic bone).

If there is evidence of a perineal tear, it is vital the correct type of tear is diagnosed. This is because while first and second degree tears can be sutured by a midwife and left to heal, third and fourth degree tears require a more extensive repair to be carried out in theatre. Thus if a woman has suffered a third degree tear but she is mis-diagnosed with a second degree tear, then her injury will be remain untreated.

What Happens If A Perineal Tear Is Not Treated?

If a perineal tear is not properly treated, a woman will soon begin to experience complications such as:-

  • Urine incontinence;
  • Faecal and flatus incontinence;
  • Pain in the perineal area;
  • Pain or lack of sensation during sexual intercourse;
  • Psychological symptoms.

Should a woman begin to experience of these symptoms after giving birth, medical advice should be sought immediately, as there may be an undiagnosed tear. If so, further treatment will be needed to repair the injury, which is likely to involve surgery. Even so, it is possible that a woman will fail to make a complete recovery.

Undetected Perineal Tears and Medical Negligence

If you have suffered a perineal tear that failed to be diagnosed, you need to speak to a medical negligence solicitor to discuss your options. If it is found that your healthcare team provided you with a level of care that fell below an acceptable standard, then you may be able to make a claim. Should you be successful, you will be awarded compensation to cover the pain and suffering you have experienced, as well as a sum to recover the general damages you have incurred.

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