ABSTRACT
Aim: The aim of this article is to present the knowledge
of current literature regarding epidemiology
and predisposing factors, classification and surgical
treatment of third degree perineal tears. Materials
and Methods: We reviewed current articles in English
language from medline and Pub-Med using as
key words “vaginal repair, third degree tear, episiotomy
and vaginal delivery”. We summarized literature
regarding predisposing factors, epidemiology,
prevention and surgical treatment of third degree
perineal tears. Results: it is demonstrated today by
several studies that widespread episiotomy is responsible
for the increasing frequency of 3rd degree lacerations
of the perineum which are significantly associated
with forceps and the use of gynecological
chair (boom) for vaginal delivery. Primiparous women
with babies weighting > 4 kgr, are at greater risk.
Two types of surgical repair: end-to-end approximation
and overlapping of torn ends of the anal sphincter,
are both related to the functional outcome of the
repair. Conclusion: Episiotomy is an important risk
factor for severe lacerations after vaginal delivery.
Midline episiotomy and assisted vaginal delivery should
be avoided whenever possible, especially in the presence
of a large baby. Recent evidence suggests that
there is no significant advantage between overlap repair
and approximation technique, with regard to
fecal incontinence.