Third- or fourth-degree perineal tear (OASI) ⚠️ 🤰
🧠 Clinical mechanism: Obstetric anal sphincter injury can impair continence and requires specialist recognition and repair.
🔎 Recognise
- After vaginal delivery, inspect for deep perineal or rectal injury; ask about persistent pain or subsequent faecal incontinence.
🛟 First assessment and action
- Escalate to senior obstetric staff for thorough perineal and rectal examination and theatre repair when confirmed.
🧪 Investigations and reassessment
- Document tear classification and repair, postoperative analgesia, antibiotic/laxative plan and follow-up per maternity policy.
⚠️ Pitfall / escalation
- An apparently minor skin tear may conceal sphincter injury; failure to diagnose at birth can cause long-term morbidity.
UK reference: Primary NHS/NICE/RCOG/GMC source.
Editorial draft, 7 November 2026: targeted source-supported educational summary, NOT independent consultant/pharmacist verification or a treatment protocol. Follow up-to-date BNF, NICE and local NHS pathways.
Related: Labour and Complications · Bleeding Postpartum