Perineal Laceration Repair

Aka: Perineal Laceration Repair, Episiotomy Repair, Obstetric Laceration Repair, Obstetrical Laceration, Female Perineal Laceration, First-degree Perineal Laceration, Second Degree Perineal Laceration, Third Degree Perineal Laceration, Fourth Degree Perineal Laceration

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II. Precautions

  1. Routine episiotomy offers no maternal benefits
    1. Limit use to fetal indications
    2. Hartmann (2005) JAMA 293:2141-8 [PubMed]

III. Epidemiology

  1. Perineal and vaginal Lacerations complicate vaginal deliveries in 79% of cases

IV. Definitions

  1. Anal Sphincter Complex
    1. Large External anal sphincter (striated muscle)
    2. Capsule
    3. Small Internal Anal Sphincter (involuntary smooth muscle, difficult to identify on exam)

V. Grading: Perineal Lacerations

  1. Perineal Lacerations WITHOUT anal sphincter involvement (50% of vaginal deliveries)
    1. First degree Laceration
      1. Vaginal Laceration
      2. Perineal skin torn without muscle involvement
    2. Second degree Laceration
      1. First degree Laceration and
      2. Perineal muscles torn
  2. Perineal Lacerations WITH anal sphincter involvement (3% of perineal Lacerations)
    1. Third degree Laceration
      1. Second degree Laceration and
      2. External anal sphincter torn
        1. Degree 3a: External anal sphincter torn<50%
        2. Degree 3b: External anal sphincter torn>50%
        3. Degree 3c: External AND internal anal sphincter torn
    2. Fourth degree Laceration (<0.5% of perineal Lacerations)
      1. Third degree Laceration AND
      2. Complete anal sphincter complex tear AND
      3. Rectal mucosa torn

VI. Risk Factors: Third and Fourth Degree Perineal Lacerations (anal sphincter involvement)

  1. Age <20 years
  2. Asian ethnicity
  3. Nulliparous
  4. Vaginal Birth after Cesarean
  5. Large fetal weight (>4000 g or 8 lb 13.1 oz)
  6. Occipitotransverse position
  7. Occipitoposterior position
  8. Epidural Anesthesia (mixed)
    1. Epidural Anesthesia reduces overall risk of perineal Lacerations
    2. Anal sphincter involvment is more likely in the perineal Lacerations that do occur
  9. Delivery Factors
    1. Lithotomy position for delivery
    2. Midline episiotomy
    3. Operative Vaginal Delivery (Vacuum Assisted Delivery, Forceps Assisted Delivery)
    4. Oxytocin
    5. Prolonged second stage of labor (>1 hour)

VII. Preparation

  1. Suture
    1. Polyglactin 910 (Vicryl) or Monofilament Polydioxanone
      1. Vicryl 3-0 on CT-1 needle
        1. Used to close vaginal mucosa and perineal muscles
      2. Vicryl 4-0 on SH needle
        1. Used to close perineal skin
        2. Used to close rectal mucosa
      3. Efficacy
        1. Polyglactin is less associated with discomfort
        2. Greenberg (2004) Obstet Gynecol 103:1308-13 [PubMed]
    2. Polydioxanone sulfate (PDS)
      1. PDS 2-0 on CT-1 needle
        1. Used to close external anal sphincter
  2. Anesthetic
    1. Lidocaine 1%
    2. Syringe 10 cc with 27 gauge 1.5 inch needle
  3. Instruments
    1. Needle driver
    2. Hemostats
    3. Suture scissors and Metzenbaum scissors
    4. Forceps with teeth
    5. Gelpi or Deaver retractor (as needed for third and fourth perineal Lacerations)
    6. Allis Clamps (2)

VIII. Management: General Approach

  1. Good lighting and tissue exposure allows for adequate Hemostasis, anatomic reapproximation, anal sphincter repair
  2. Minor Lacerations (first and Second Degree Perineal Lacerations)
    1. First and Second Degree Perineal Lacerations with adequate Hemostasis do not require suturing
      1. Outcomes between repair and no repair are similar at 8 weeks
      2. Pain (including Dyspareunia) is less without repair at 3 months
      3. ACOG supports both conservative treatment (no repair) and perineal repair
      4. Elharmeel (2011) Cochrane Database Syst Rev (8): CD008534 [PubMed]
    2. Other minor vaginal and vulvar Lacerations
      1. Minor vaginal wall, periclitoral, periurethral or labial tears do not require repair
      2. Repair is only indicated for Hemostasis and correction of distorted tissue

IX. Management: Vaginal Laceration Repair

  1. Description
    1. Closure of vaginal mucosa and rectovaginal fascia or septum (behind hymenal ring)
    2. Vaginal tears may involve both sides of vaginal floor
  2. General
    1. Indicated in first through fourth degree Lacerations
    2. Repaired with Vicryl 3-0 on CT-1 needle
  3. Anchor Suture 1 cm above apex of vaginal Laceration
  4. Use continuous, Running stitch (continuous) to close vaginal mucosa
    1. Locking Suture is optional (used for Hemostasis)
    2. Continuous RunningSuture is preferred over interrupted, associated with less pain
  5. Each pass should include
    1. Vaginal mucosa
    2. Rectovaginal fascia (important for vaginal support)
  6. Continue RunningSuture up to hymenal ring
    1. May be tied off proximal to hymenal ring or
    2. May be passed under hymenal ring to perineum
      1. May be used for closing perineal skin (see below)

X. Management: Perineal muscle repair

  1. Description
    1. Bulbocavernosus and transverse perineal muscle reapproximated and closed
  2. General
    1. Indicated in second through fourth degree Lacerations
    2. Repaired with Vicryl 3-0 on CT-1 needle
    3. Avoid locking Suture
  3. Close each muscle body with interrupted figure 8 Suture
    1. Closure of bulbocavernosus muscle
      1. Located immediately below introitus
      2. Located above transverse perineal muscle
    2. Closure of transverse perineal muscle
      1. Located above external anal sphincter

XI. Management: Rectal mucosa and internal sphincter repair

  1. Performed by most experienced clinician
  2. Repair before the external anal sphincter
  3. Description
    1. Closure of rectal mucosa
    2. Closure of internal anal sphincter
  4. General
    1. Indicated in fourth degree Lacerations
    2. Closed with Vicryl 4-0 on SH needle
    3. Gelpi retractor used to maximize visualization
  5. Close rectal mucosa with RunningSuture
    1. Start above apex of rectal mucosal tear
    2. Keep Suture passes closely spaced
    3. Do not Suture complete thickness of rectal mucosa
      1. Risk of Anal Fistula formation
    4. Continue Suture to anal verge on perineal skin
  6. Close internal anal sphincter
    1. Allis clamp placed at each end of internal sphincter
    2. Close internal anal sphincter with monofilament PDS 3-0 on tapered needle

XII. Management: External anal sphincter repair

  1. Description
    1. Closure of external anal sphincter
  2. General
    1. Indicated in third and fourth degree Lacerations
    2. Repaired with Polydioxanone (PDS) 2-0 on CT-1 needle
  3. Identify external anal sphincter ends
    1. Clamp each external anal sphincter muscle
    2. Must include rectal sphincter sheath (capsule)
      1. Must be included in closure for adequate strength
  4. Close external anal sphincter
    1. Option 1: End to end external anal sphincter closure
      1. Standard method and preferred for partial spincter Lacerations
        1. Some studies have shown with poorer functional outcomes compared with option 2
        2. However later studies have shown similar outcomes
        3. Farrell (2012) Obstet Gynecol 120(4): 803-8 [PubMed]
        4. Kammerer-Doak (1999) Am J Obstet Gynecol 181:1317 [PubMed]
        5. Rygh (2010) Acta Obstet Gynecol Scand 89(10):1256-62 [PubMed]
      2. Close sphincter with 4 interrupted Sutures including the connective tissue
        1. Simple interrupted Sutures or figure of 8
          1. Figure of 8 Suture may provide better support, but may risk tissue ischemia
          2. British guidelines recommend simple interrupted Suture
        2. First
          1. Posterior (3:00) position including capsule
        3. Next
          1. Inferior (6:00) position
          2. Superior (12:00) position
        4. Last
          1. Anterior (9:00) position
    2. Option 2: Overlapping external anal sphincter closure
      1. May be preferred method due to better outcomes
      2. May require dissection of spincter ends to allow for overlap
      3. Overlap each end of external anal sphincter
        1. Allow sufficient overlap to place 3 Sutures
      4. Place 3 mattress Sutures through overlapped edges
        1. Pass Suture through superior end and inferior end
        2. Pass Suture through inferior, then superior end
        3. Tie at top overlying superior sphincter edge

XIII. Management: Perineal Skin Repair

  1. Description
    1. Bulbocavernosus and transverse perineal muscle closed
  2. General
    1. Indicated in first through fourth degree Lacerations
    2. Closure of perineal skin is controversial
      1. May be associated with higher rate perineal pain
        1. Gordon (1998) Br J Obstet Gynaecol 105:435-40 [PubMed]
      2. Some advocate closure only as needed
        1. Indicated if skin not well approximated
      3. Surgical glue has been used with less pain and similar outcome for first degree Lacerations
        1. Feigenberg (2014) Biomed Res Int +PMID: 25089271 [PubMed]
    3. Repair materials
      1. Vicryl 4-0 on SH needle or
      2. Vicryl 3-0 on CT-1 continued from vaginal mucosa
  3. Running deep Suture
    1. Start unlocked continuous Suture from below introitus (anterior to hymenal ring)
      1. May be continued from vaginal mucosa
        1. Passed from behind hymenal ring via deep layer
    2. Continue RunningSuture down to posterior tear edge
  4. Running subcuticular Suture
    1. Subcuticular Suture starts at posterior perineal tear
    2. Run back up to introitus
    3. Tie off perineal skin Suture
      1. Pass through deep tissue and tie behind hymen or
      2. Tie deep to perineal skin

XIV. Management: Home

  1. Constipation Prevention
    1. Osmotic Laxatives (e.g. Miralax) to prevent Constipation and straining at stool
    2. Decreases risk of perineal repair breakdown
    3. Avoid Opioids
    4. Avoid rectal suppositories
  2. Analgesia
    1. Cool compress to perineum for first 2 days after delivery
    2. Acetaminophen alternated with NSAIDs (e.g. Ibuprofen) offers sufficient analgesia
    3. Consider local infection if pain is severe enough to require Opioid Analgesics
    4. Avoid Topical Analgesics (ineffective)
  3. Pelvic Floor Exercises
    1. Start 2-3 days after delivery

XV. Complications

  1. Local lnfection
  2. Chronic perineal pain including Sexual Dysfunction (e.g. Dyspareunia)
    1. Associated with perineal skin closure
  3. Urinary Incontinence and Fecal Incontinence
    1. Associated with third and fourth degree tears
    2. Liquid Stool Incontinence at 5 years in 17% of anal sphincter injuries (double the risk of first and second degree tears)
  4. Anal Fissure
    1. Associated with fourth degree tears

XVI. Prevention: Perineal Lacerations

  1. Antepartum
    1. Digital perineal self massage starting at 35 weeks
      1. Beckmann (2013) Cochrane Database Syst Rev (4): CD005123 [PubMed]
  2. Second Stage of Labor
    1. Perineal massage
    2. Warm compress to perineum
  3. Delivery
    1. Perineal support
      1. First and second fingers of one of examiner's hands pinches together mid-posterior perineum
      2. Other hand slows delivery of fetal head
  4. Avoid unhelpful maneuvers that do not reduce third or Fourth Degree Perineal Lacerations
    1. Avoid midline episiotomy (aside from other indication such as Shoulder Dystocia Management)
    2. Avoid mediolateral episiotomy
  5. Other measures that do NOT reduce third or Fourth Degree Perineal Lacerations
    1. Altering birth position

XVII. References

  1. Arnold (2021) Am Fam Physician 103(12): 745-52 [PubMed]
  2. Leeman (2003) Am Fam Physician 68:1585-90 [PubMed]
  3. Marquardt in Pfenninger (1994) Procedures, p. 785-93
  4. Miller (1989) Obstetrics Illustrated, p. 374-6

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Related Studies

Ontology: Repair of episiotomy (C0014585)

Concepts Therapeutic or Preventive Procedure (T061)
ICD10 90472-00
SnomedCT 72197005, 150009005, 177222006
English Episiotomy with repair, episioplasty, episiorrhaphy, Repair of episiotomy, Episiorrhaphy (procedure), episiotomy repair, episiotomy repair (treatment), Episiorrhaphy, Suturing of episiotomy, Repair of episiotomy (procedure), Episiorrhaphy (procedure) [Ambiguous], Repair;episiotomy
Spanish episiorrafia (procedimiento), episiorrafia (concepto no activo), episiorrafia, reparación de episiotomía (procedimiento), reparación de episiotomía, sutura de episiotomía
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Repair of obstetric laceration (C0195666)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 372456005, 150012008, 39754001, 287950008
English Obstet laceration repair NOS, Obstetric laceration repair NOS, Episiorrhaphy for obstetrical laceration, Obstetric laceration repair NOS (procedure), Repair of obstetric laceration, Repair of obstetric laceration (procedure)
Spanish reparación de laceración obstétrica, SAI, epifisiorrafia por laceración obstétrica, reparación de laceración obstétrica, SAI (procedimiento), reparación de una laceración obstétrica, reparación de una laceración obstétrica (procedimiento), Obstetric laceration repair NOS, reparación de laceración obstétrica (procedimiento), reparación de laceración obstétrica
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Obstetrical laceration (C0269859)

Concepts Injury or Poisoning (T037)
ICD9 664.41, 664.4
ICD10 O70 , O70.9
SnomedCT 123190002, 199938007, 68953003, 199937002, 12172008, 199941003, 249219008, 398019008, 392280004, 397952002
English Perineal laceration unspecif., Perineal tear unspecified, Perineal tear unspecified NOS, Unspecified perineal laceration during delivery NOS, Unspecified perineal laceration during delivery, unspecified, Genital tear from childbirth, Perineal laceration during delivery, unspecified, Perineal tear from childbirth, perineal laceration during delivery, perineal laceration during delivery (diagnosis), Obstetrical laceration, post-delivery exam showing perineal laceration, post-delivery exam showing laceration of perineum (physical finding), post-delivery exam showing laceration of perineum, Ob perineal lac NOS-del, Unspecified perineal laceration, delivered, with or without mention of antepartum condition, Unspecified perineal laceration during delivery, Unspecified perineal laceration, with delivery, Unspecified perineal laceration during delivery (disorder), Unspecified perineal laceration during delivery, unspecified (disorder), Unspecified perineal laceration during delivery NOS (disorder), obstetrical laceration (diagnosis), postpartum / peurperal complications trauma to perineum during delivery, Trauma to perineum during delivery (diagnosis), Genital tear resulting from childbirth (diagnosis), obstetrical trauma genital tear resulting from childbirth, Genital tear resulting from childbirth, Perineal laceration during delivery, Perineal tear resulting from childbirth, Genital tear resulting from childbirth (disorder), Obstetrical laceration (disorder), Perineal laceration during delivery (disorder), Trauma to perineum during delivery (disorder), Trauma to perineum during delivery, Obstetrical laceration, NOS, Perineal laceration during delivery, NOS, Trauma to perineum during delivery, NOS, Obstetrical laceration -RETIRED-, Central laceration of perineum during delivery, Laceration;perineum (obstet), perineal laceration (obstetric)
German Dammriss unter der Geburt, nicht naeher bezeichnet, Dammriss unter der Geburt, unspezifischer Dammriss waehrend der Entbindung, unspezifischer Dammriss, bei Entbindung
Korean 분만중 회음부 열상, 상세불명의 분만중 회음부 열상
Spanish desgarro genital como consecuencia del parto, desgarro genital debido al parto, desgarro genital como consecuencia del parto (trastorno), desgarro genital debido al parto (trastorno), Desgarro perineal no especificado, con parto, Desgarro perineal no especificado durante el parto, laceración obstétrica (concepto no activo), laceración perineal durante el parto, no especificada, SAI (trastorno), desgarro obstétrico, laceración perineal durante el parto, no especificada, laceración perineal durante el parto, no especificada (trastorno), trauma perineal durante el parto, traumatismo del perineo durante el parto (concepto no activo), laceración perineal durante el parto, no especificada, SAI, laceración perineal intraparto no especificada - no especificado (trastorno), laceración perineal intraparto no especificada - no especificado, laceración obstétrica (trastorno), laceración obstétrica, laceración perineal durante el parto (trastorno), laceración perineal durante el parto, traumatismo del perineo durante el parto, traumatismo perineal durante el parto (trastorno), traumatismo perineal durante el parto
Czech Blíže neurčená trhlina hráze během porodu, Blíže neurčená trhlina hráze, při porodu
Dutch perineale ruptuur niet-gespecificeerd tijdens bevalling, niet-gespecificeerde perineale ruptuur, met bevalling, Perineumruptuur, niet gespecificeerd, Perineumruptuur tijdens bevalling
French Déchirure obstétricale non précisée du périnée, Déchirure non précisée du périnée pendant l'accouchement
Hungarian Nem meghatározott perinealis laceratio szülés idején, Nem meghatározott perinealis laceratio, szüléssel
Italian Lacerazione perineale non specificata, parto espletato, Lacerazione perineale non specificata durante il parto
Japanese ｼｮｳｻｲﾌﾒｲﾉｴｲﾝﾚｯｼｮｳ, 詳細不明の会陰裂傷
Portuguese Laceração perineal NE durante a expulsão, Laceração perineal NE, com parto consumado
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: First-degree perineal laceration during delivery (C0269863)

Definition (NCI) Injury to perineal skin only. (reVITALize)(NICHD)
Concepts Injury or Poisoning (T037)
ICD9 664.0
ICD10 O70.0
SnomedCT 123138006, 199914008, 199915009, 199922001, 156225004, 57759005
English 1st degree perineal tear unsp., First degree perineal laceration during delivery, First degree perineal tear, First degree perineal tear NOS, First degree perineal tear during delivery NOS, First degree perineal tear during delivery, unspecified, First degree perineal tear during delivery, first-degree perineal laceration during delivery (diagnosis), first-degree perineal laceration during delivery, First-degree perineal laceration during delivery, post-delivery exam showing first degree laceration of perineum (physical finding), post-delivery exam showing first degree laceration of perineum, post-delivery exam showing first degree perineal laceration, First degree perineal tear during delivery NOS (disorder), First degree perineal tear during delivery, unspecified (disorder), Obstetrical laceration, first degree (disorder), First degree perineal tear (disorder), First Degree Perineal Laceration, Laceration of superficial layers of perineal structures, Obstetrical laceration, first degree, First degree perineal laceration, First degree perineal laceration (disorder), laceration; vagina, complicating delivery, with perineum, laceration; vulva, complicating delivery, perineal rupture, obstetric; first degree, rupture; perineum, complicating delivery, first degree, vagina; laceration, complicating delivery, with perineum, vulva; laceration, complicating delivery, First degree perineal laceration, NOS, Obstetrical laceration, first degree -RETIRED-
German Dammriss 1. Grades unter der Geburt, Dammriss ersten Grades waehrend der Entbindung
Korean 분만중 제1도 회음부 열상
Czech Trhlina hráze prvního stupně během porodu
Dutch perineale ruptuur eerstegraads, tijdens bevalling, laceratie; vagina, complicatie bevalling, met perineum, laceratie; vulva, complicatie van bevalling, perineumruptuur; obstetrisch, eerstegraads, ruptuur; perineum, complicatie van bevalling, eerstegraads, vagina; laceratie, complicatie van bevalling, met perineum, vulva; laceratie, complicatie van bevalling, Eerstegraads perineumruptuur
French Déchirure obstétricale du périnée du premier degré
Hungarian Első-fokú gáttáji laceratio szülés idején
Italian Lacerazione perineale di primo grado durante il parto
Japanese 会陰裂傷第１度, ｴｲﾝﾚｯｼｮｳﾀﾞｲ1ﾄﾞ
Portuguese Laceração perineal do 1º grau durante a expulsão
Spanish Desgarro perineal de primer grado durante el parto, desgarro perineal de primer grado durante el parto, SAI, laceración obstétrica, primer grado (concepto no activo), desgarro perineal de primer grado durante el parto, SAI (trastorno), desgarro perineal de primer grado durante el parto, no especificado, desgarro perineal de primer grado durante el parto, no especificado (trastorno), laceración de las capas superficiales de las estructuras perineales, laceración obstétrica, primer grado, laceración perineal de primer grado (trastorno), laceración perineal de primer grado
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Second degree perineal laceration (C0269870)

Definition (NCI) Injury to perineum involving perineal muscles but not involving anal sphincter. (reVITALize)(NICHD)
Concepts Injury or Poisoning (T037)
ICD9 664.11, 664.1
ICD10 O70.1
SnomedCT 123139003, 199923006, 199927007, 199924000, 156226003, 6234006
English 2nd degree perineal tear unsp., Second degr.perineal tear NOS, Second degree perineal laceration during delivery, Second degree perineal tear, Second degree perineal tear during delivery NOS, Second degree perineal tear during delivery, unspecified, Second degree perineal tear during delivery, second-degree perineal laceration during delivery, second-degree perineal laceration during delivery (diagnosis), post-delivery exam showing second degree perineal laceration, post-delivery exam showing second degree laceration of perineum (physical finding), post-delivery exam showing second degree laceration of perineum, Del w 2 deg lacerat-del, Second-degree perineal laceration, delivered, with or without mention of antepartum condition, Second-degree perineal laceration during delivery, Second-degree perineal laceration, with delivery, Pelvic floor tear, Obstetrical laceration, second degree (disorder), Second degree perineal tear during delivery NOS (disorder), Perineal muscle tear, Second degree perineal tear (disorder), Second degree perineal tear during delivery, unspecified (disorder), Second Degree Perineal Laceration, Obstetrical laceration, second degree, Second degree perineal laceration, Laceration of inner AND/OR muscular layers of perineal structures, Second degree perineal laceration (disorder), laceration; perineum, second degree, complicating delivery, complicating delivery, laceration; vagina, complicating delivery, with perineum, muscles, laceration; vagina, with perineum and muscles, complicating delivery, Laceration of inner and muscular layers of perineal structures, Second degree perineal laceration, NOS, Obstetrical laceration, second degree -RETIRED-
German Dammriss 2. Grades unter der Geburt, Dammriss zweiten Grades, bei Entbindung, Dammriss zweiten Grades waehrend der Entbindung
Korean 분만중 제2도 회음부 열상
Czech Trhlina hráze druhého stupně, při porodu, Trhlina hráze druhého stupně během porodu
Dutch perineale ruptuur tweedegraads, tijdens bevalling, tweedegraads perineale ruptuur, met bevalling, laceratie; perineum, tweedegraads, complicatie bevalling, complicatie bevalling, laceratie; vagina, complicatie bevalling, met perineum, spieren, laceratie; vagina, met perineum en spieren, complicatie bevalling, Tweedegraads perineumruptuur
French Déchirure obstétricale du périnée du deuxième degré, Déchirure du périnée du deuxième degré pendant l'accouchement
Hungarian Másod-fokú perinealis laceratio szülés idején, Másod-fokú perinealis laceratio, szüléssel
Italian Lacerazione perineale di secondo grado durante il parto, Lacerazione perineale di secondo grado, con parto
Japanese ｴｲﾝﾚｯｼｮｳﾀﾞｲ2ﾄﾞ, 会陰裂傷第２度
Portuguese Laceração de 2º grau do períneo, com parto consumado, Laceração de 2º grau do períneo durante a expulsão
Spanish Desgarro perineal de segundo grado, con parto, Desgarro perineal de segundo grado durante el parto, desgarro perineal de segundo grado durante el parto, no especificado (trastorno), laceración obstétrica, segundo grado (concepto no activo), desgarro perineal de segundo grado durante el parto, SAI (trastorno), desgarro perineal de segundo grado durante el parto, SAI, desgarro perineal de segundo grado durante el parto, no especificado, laceración de las capas interna Y/O muscular de las estructuras perineales, laceración de las capas interna y muscular de las estructuras perineales, laceración obstétrica, segundo grado, laceración perineal de segundo grado (trastorno), laceración perineal de segundo grado
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Third degree perineal laceration (C0269874)

Definition (NCI) Injury to perineum involving anal sphincter complex. (adapted from reVITALize)(NICHD)
Concepts Injury or Poisoning (T037)
ICD9 664.21, 664.2
ICD10 O70.2
SnomedCT 123191003, 156227007, 199932008, 199928002, 199929005, 10217006
English 3rd degree perineal tear unsp., Third degree perineal laceration during delivery, Third degree perineal tear, Third degree perineal tear NOS, Third degree perineal tear during delivery NOS, Third degree perineal tear during delivery, unspecified, Third degree perineal tear during delivery, third-degree perineal laceration during delivery, third-degree perineal laceration during delivery (diagnosis), post-delivery exam showing third degree laceration of perineum, post-delivery exam showing third degree laceration of perineum (physical finding), post-delivery exam showing third degree perineal laceration, Del w 3 deg lacerat-del, Third-degree perineal laceration, delivered, with or without mention of antepartum condition, Third-degree perineal laceration during delivery, Third-degree perineal laceration, with delivery, Obstetrical laceration, third degree (disorder), Third degree perineal tear (disorder), Third degree perineal tear during delivery, unspecified (disorder), Third degree perineal tear during delivery NOS (disorder), Third Degree Perineal Laceration, Obstetrical laceration, third degree, Third degree perineal laceration, Laceration of tissues between vaginal AND/OR perineal muscular layers and rectal mucosa, Third degree perineal laceration (disorder), laceration; anus, complicating delivery, laceration; perineum, third degree, complicating delivery, laceration; sphincter ani, complicating delivery, perineal rupture, obstetric; anus, perineal rupture, obstetric; third degree, anus; perineal rupture, obstetric, Laceration of tissues between vaginal and perineal muscular layers and rectal mucosa, Third degree perineal laceration, NOS, Obstetrical laceration, third degree -RETIRED-
German Dammriss 3. Grades unter der Geburt, Dammriss dritten Grades waehrend der Entbindung, Dammriss dritten Grades, bei Entbindung
Korean 분만중 제3도 회음부 열상
Czech Trhlina hráze třetího stupně, při porodu, Trhlina hráze třetího stupně během porodu
Dutch perineale ruptuur derdegraads, tijdens bevalling, derdergraads perineale ruptuur, met bevalling, anus; perineumruptuur, obstetrisch, laceratie; anus, complicatie bevalling, laceratie; perineum, derdegraads, complicatie bevalling, laceratie; sphincter ani, complicatie bevalling, perineumruptuur; obstetrisch, anus, perineumruptuur; obstetrisch, derdegraads, Derdegraads perineumruptuur
French Déchirure obstétricale du périnée du troisième degré, Déchirure du périnée du troisième degré pendant l'accouchement
Hungarian Harmadfokú perinealis laceratio, szüléssel, Harmadfokú perinealis laceratio szülés idején
Italian Lacerazione perineale di terzo grado durante il parto, Lacerazione perineale di terzo grado, parto espletato
Japanese 会陰裂傷第３度, ｴｲﾝﾚｯｼｮｳﾀﾞｲ3ﾄﾞ
Portuguese Laceração do períneo do 3º grau durante a expulsão, Laceração do períneo do 3º grau, com parto consumado
Spanish Desgarro perineal de tercer grado, con parto, Desgarro perineal de tercer grado durante el parto, desgarro perineal de tercer grado durante el parto, no especificado, desgarro perineal de tercer grado durante el parto, SAI (trastorno), laceración obstétrica, tercer grado, laceración obstétrica, tercer grado (concepto no activo), desgarro perineal de tercer grado durante el parto, no especificado (trastorno), desgarro perineal de tercer grado durante el parto, SAI, laceración de los tejidos comprendidos entre las capas musculares de la vagina Y/O el perineo, y la mucosa rectal, laceración de los tejidos comprendidos entre las capas musculares de la vagina y el perineo, y la mucosa rectal, laceración perineal de tercer grado (trastorno), laceración perineal de tercer grado
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Repair of perineal tear (procedure) (C0404427)

Concepts Therapeutic or Preventive Procedure (T061)
SnomedCT 150010000, 237026005
CPT 56810
English Repair of perineal tear (procedure), Repair of perineum, Repair of perineal tear, Suturing of perineal tear, Perineal tear repair
Spanish reparación de laceración perineal (procedimiento), reparación de laceración perineal, sutura de laceración perineal
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Laceration of female perineum (C0561821)

Concepts Injury or Poisoning (T037)
SnomedCT 283970001
Spanish laceración del perineo femenino (trastorno), desgarro del perineo femenino, laceración del perineo femenino, laceración del periné femenino, laceración del periné femenino (trastorno)
English Tear of female perineum, Laceration of female perineum, Laceration of female perineum (disorder)
Derived from the NIH UMLS (Unified Medical Language System)

Ontology: Fourth degree perineal laceration (C1275806)

Definition (NCI) Injury to perineum involving anal sphincter complex and internal anal sphincter and anal epithelium. (reVITALize)(NICHD)
Concepts Finding (T033)
ICD9 664.31, 664.3
ICD10 O70.3
SnomedCT 399031001, 123192005, 8719006, 156228002, 399338000, 199933003, 199936006
English 4th degree perineal tear unsp., Complete perineal tear, Fourth degr.perineal tear NOS, Fourth degree perineal laceration during delivery, Fourth degree perineal tear during delivery NOS, Fourth degree perineal tear during delivery, unspecified, Fourth degree perineal tear during delivery, Obstetric laceration, fourth degree, fourth-degree perineal laceration during delivery (diagnosis), fourth-degree perineal laceration during delivery, post-delivery exam showing fourth degree perineal laceration, post-delivery exam showing fourth degree laceration of perineum (physical finding), post-delivery exam showing fourth degree laceration of perineum, Del w 4 deg lacerat-del, Fourth-degree perineal laceration, delivered, with or without mention of antepartum condition, Fourth-degree perineal laceration during delivery, Fourth-degree perineal laceration, with delivery, Complete perineal tear (disorder), Obstetric laceration, fourth degree (disorder), Obstetrical laceration, fourth degree (disorder), Obstetrical laceration, fourth degree, Fourth degree perineal tear during delivery, unspecified (disorder), Fourth degree perineal tear during delivery NOS (disorder), Fourth Degree Perineal Laceration, CPT - Complete perineal tear, Fourth degree perineal tear, Fourth degree perineal laceration (disorder), Fourth degree perineal laceration, laceration; anus, complicating delivery, with anal or rectal mucosa, laceration; perineum, fourth degree, complicating delivery, laceration; rectovaginal, complicating delivery, with perineum, involving anal or rectal mucosa, laceration; rectovaginal, with perineum and anal or rectal mucosa, complicating delivery, laceration; sphincter ani, with mucosa, complicating delivery, Fourth degree perineal laceration, NOS, Obstetrical laceration, fourth degree -RETIRED-
Spanish laceración perineal de cuarto grado, desgarro perineal de cuarto grado, laceración perineal de cuarto grado (trastorno), laceración perianal de cuarto grado (trastorno), laceración perianal de cuarto grado, Desgarro perineal de cuarto grado, con parto, Desgarro perineal de cuarto grado durante el parto, desgarro obstétrico de cuarto grado (trastorno), desgarro perineal de cuarto grado durante el parto, no especificado (trastorno), desgarro perineal de cuarto grado durante el parto, SAI (trastorno), laceración obstétrica, cuarto grado, desgarro perineal de cuarto grado durante el parto, no especificado, desgarro obstétrico de cuarto grado, laceración obstétrica, cuarto grado (concepto no activo), desgarro perineal de cuarto grado durante el parto, SAI
German Dammriss 4. Grades unter der Geburt, Dammriss vierten Grades waehrend der Entbindung, Dammriss vierten Grades, bei Entbindung
Korean 분만중 제4도 회음부 열상
Czech Trhlina hráze čtvrtého stupně, při porodu, Trhlina hráze čtvrtého stupně během porodu
Dutch vierdegraads perineale ruptuur, met bevalling, perineale ruptuur vierdegraads, tijdens bevalling, laceratie; anus, complicatie bevalling, met anaal of rectaal slijmvlies, laceratie; perineum, vierdegraads, complicatie bevalling, laceratie; rectovaginaal, complicatie bevalling, met perineum, en anaal of rectaal slijmvlies, laceratie; rectovaginaal, met perineum en anaal of rectaal slijmvlies, complicatie bevalling, laceratie; sphincter ani, met slijmvlies, complicatie bevalling, Vierdegraads perineumruptuur
French Déchirure obstétricale du périnée du quatrième degré, Déchirure du périnée du quatrième degré pendant l'accouchement
Hungarian Perinealis negyedik-fokú horzsolás, szüléssel, Negyed-fokú gáttáji horzsolás szülés idején
Italian Lacerazione perineale di quarto grado durante il parto, Lacerazione perineale di quarto grado, parto espletato
Japanese ｴｲﾝﾚｯｼｮｳﾀﾞｲ4ﾄﾞ, 会陰裂傷第４度
Portuguese Laceração do períneo do 4º grau, com parto consumado, Laceração do períneo do 4º grau durante o parto
Derived from the NIH UMLS (Unified Medical Language System)

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