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First Degree Laceration
A first degree perineal laceration extends only through the vaginal and perineal skin.
Repair: Place a single layer of interrupted 3-O chromic or vicryl sutures about 1 cm apart.
Second Degree Laceration and Repair of Midline Episiotomy
A second degree laceration extends deeply into the soft tissues of the perineum, down to, but not including, the external anal sphincter capsule. The disruption involves the bulbocavernosus and transverseperineal muscles.
Repair
1. Proximate the deep tissues of the perineal body by placing 3-4 interrupted 2-O or 3-O chromic or vicryl absorbable sutures. Reapproximate the superficial layers of the perineal body with a running suture extending to the bottom of the episotomy.
2. Identify the apex of the vaginal laceration. Suture the vaginal mucosa with running, interlocking, 3-O chromic or vicryl absorbable suture.
3. Close the perineal skin with a running, subcuticular suture. Tie off the suture and remove the needle.
III. Third Degree Laceration
A. This laceration extends through the perineum and through the anal sphincter.
B. Repair
1. Identify each severed end of the external anal sphincter capsule, and grasp each end with an Allis clamp.
2. Proximate the capsule of the sphincter with 4 interrupted sutures of 2-O or 3-O vicryl suture, making sure the sutures do not penetrate the rectal mucosa.
3. Continue the repair as for a second degree laceration as above. Stool softeners and sitz baths are prescribed post-partum.
IV. Fourth-Degree Laceration
A. The laceration extends through the perineum, anal sphincter, and extends through the rectal mucosa to expose the lumen of the rectum.