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Third‐ and fourth‐degree tears: A review of the current evidence for prevention and management
Author(s) -
Wilson Alyce N.,
Homer Caroline S.E.
Publication year - 2020
Publication title -
australian and new zealand journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.734
H-Index - 65
eISSN - 1479-828X
pISSN - 0004-8666
DOI - 10.1111/ajo.13127
Subject(s) - medicine , massage , episiotomy , psychological intervention , medline , systematic review , perineum , family medicine , pregnancy , alternative medicine , surgery , nursing , law , pathology , biology , political science , genetics
Background Third‐ and fourth‐degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third‐ and fourth‐degree tears relative to countries of similar economic development. Aims We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third‐ and fourth‐degree perineal tears in Australian maternity centres. Materials and Methods We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Results Twenty‐six systematic reviews were identified. The most common risk factors reported in the literature for third‐ and fourth‐degree tears included primiparity, mother’s ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births. Conclusions Third‐ and fourth‐degree perineal tears are associated with immediate and long‐term implications for women and health systems. Evidence‐based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do.