Lacerations: Risk Factors & Anatomy

Contents

Complicated Lower Genital Tract Lacerations.
Module by: Nicole Wade & Katherine Rabicki

Learning Objectives

Review risk factors for complicated lacerations
Review relevant pelvic and perineal anatomy
Review basic principles of perineal lacerations
- Instruments
- Materials
Propose an approach for the following complicated lacerations:
- Deep vaginal
- Anterior and periurethral
- Third degree (Obstetrical Anal Sphincter Injury i.e. OASIS)
- Fourth degree (OASIS)
- Cervical
- Episiotomy
Review post-repair care principles

Risk Factors for Complicated Lacerations

Maternal risk factors	Delivery risk factors	Infant risk factors
Primiparity	Midline episiotomy +/- forceps/vacuum	OP presentation +/- instrumental delivery
Infibulation	Vacuum or forceps use	Birthweight >4000g
Race	Mediolateral episiotomy	Postmaturity
Age >27	Epidural	Malpresentation
Maternal diabetes	Second stage >1h	Fetal distress
	Shoulder dystocia
	TOLAC
	Water birth
	Oxytocin augmentation

*Risk factors have been arranged in order of descending odds ratio
[Ref: Williams Obstetrics; OASIS – Prevention, Recognition, and Repair (JOGC Guideline 330)]