O70.20

Clinical Causes: Use of instrumentation like forceps or vacuum extractor during delivery Prolonged or difficult labor that exerts excessive pressure on the perineum Large baby (macromelia) or a rapid delivery Births involving different positions that put stress on the perineal area Previous perineal trauma or surgeries that weaken tissue Maternal factors like age, parity, and tissue elasticity

Key Symptoms: Severe pain in the perineal area during and after delivery Visible tearing or bleeding from the perineal region Swelling, bruising, or hematoma in the perineal area Difficulty controlling bowel movements due to sphincter injury Discomfort or pain during urination Potential leakage of stool or gas if the anal sphincter is damaged

Diagnosis Path: Healthcare providers diagnose a third degree perineal laceration through physical examination immediately after delivery. They assess the extent of tissue damage, including the anal sphincter muscles and surrounding tissues. In some cases, additional imaging or investigations like an endoanal ultrasound may be used to evaluate sphincter injuries, especially if symptoms persist or complications arise.

Treatment Protocols: Treatment for a third degree perineal laceration involves surgical repair to close the torn tissues, including the muscles and skin. This procedure typically occurs shortly after delivery to promote proper healing. Postoperative care involves pain management, maintaining hygiene to prevent infection, and possibly antibiotics. Follow-up examinations may be necessary to assess healing and address any complications such as infection, persistent pain, or sphincter dysfunction. In some cases, physical therapy, including pelvic floor exercises, can aid recovery and improve function.