Concept and clinical practice of repairing lacerations of perineum and other parts based on anatomy

WANG Le-le; ZHENG Zheng

doi:10.19538/j.fk2026040109

PDF(4164 KB)

Chinese Journal of Practical Gynecology and Obstetrics ›› 2026, Vol. 42 ›› Issue (4) : 419-424. DOI: 10.19538/j.fk2026040109

Concept and clinical practice of repairing lacerations of perineum and other parts based on anatomy

WANG Le-le ,
ZHENG Zheng

Author information +

History +

Abstract

Obstetric lacerations are common complications of vaginal delivery，and inadequate repair is prone to inducing long-term complications such as pelvic floor dysfunction. Therefore，standardized repair of obstetric lacerations is of great significance for improving the quality of obstetric clinical practice. The rectovaginal septum，perineal body，anal sphincter complex and other structures are key components in maintaining the structural integrity and normal physiological function of the pelvic floor，and they are vulnerable to injuries during vaginal delivery. Hence，the repair of such obstetric lacerations should emphasize structural and functional reconstruction based on anatomy，and the repair strategy must abide by the core principle of "prioritizing anatomical reduction and functional orientation". Prior to suture，the degree of lacerations should be fully evaluated. Clinical interventions should include adequate hemostasis，layered apposition of injured tissues，and reconstruction of the anatomical continuity of muscles and fasciae. In addition，the implementation of comprehensive perioperative management centering on functional recovery is also essential，so as to promote the overall rehabilitation of the pelvic floor structure and function of patients.

Key words

vaginal delivery / obstetric lacerations / rectovaginal septum / obstetric-related anal sphincter injuries / anatomical reduction

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

WANG Le-le , ZHENG Zheng. Concept and clinical practice of repairing lacerations of perineum and other parts based on anatomy[J]. Chinese Journal of Practical Gynecology and Obstetrics. 2026, 42(4): 419-424 https://doi.org/10.19538/j.fk2026040109

References

List( Publishing order | Descend order by publishing year | Descend order by cited within ) Chart analysis

[1]	张勤建, 颜建英. 会阴Ⅲ-Ⅳ度裂伤及特殊裂伤的预防和处理[J]. 中国实用妇科与产科杂志, 2022, 38(8):780-783. DOI:10.19538/j.fk2022080104. Cited in this article [1]

[2]	Bols EM, Hendriks EJ, Berghmans BC, et al. A systematic review of etiological factors for postpartum fecal incontinence[J]. Acta Obstet Gynecol Scand, 2010, 89(3):302-314. DOI:10.3109/00016340903576004. Cited in this article [1]

[3]	Gommesen D, Nohr EA, Qvist N, et al. Obstetric perineal ruptures-risk of anal incontinence among primiparous women 12 months postpartum:a prospective cohort study[J]. Am J Obstet Gynecol, 2020, 222(2):165.e1-165.e11. DOI:10.1016/j.ajog.2019.08.026. Cited in this article [1]

[4]	DeLancey JOL, Masteling M, Pipitone F, et al. Pelvic floor injury during vaginal birth is life-altering and preventable: what can we do about it?[J]. Am J Obstet Gynecol, 2024, 230(3):279-294.e2. DOI:10.1016/j.ajog.2023.11.1253. Cited in this article [1]

[5]	Sultan AH, Kamm MA, Hudson CN, et al. Anal-sphincter disruption during vaginal delivery[J]. N Engl J Med, 1993, 329(26):1905-1911. DOI:10.1056/NEJM199312233292601. Cited in this article [1]

[6]	Dudding TC, Vaizey CJ, Kamm MA. Obstetric anal sphincter injury: incidence,risk factors,and management[J]. Ann Surg, 2008, 247(2):224-237. DOI:10.1097/SLA.0b013e318142cdf4. Cited in this article [1]

[7]	陈功立, 漆洪波. 产后出血的个体化处理[J]. 中国实用妇科与产科杂志, 2026, 42(1):40-43. DOI:10.19538/j.fk2026010110. Cited in this article [1]

[8]	许圳鹏, 孙桂东, 陈玉根, 等. 基于盆底整体理论的前侧括约肌成形术治疗Ⅲ-Ⅳ度产伤引起的大便失禁[J]. 中国实用妇科与产科杂志, 2025, 41(5):502-507. DOI:10.19538/j.fk2025050107. Cited in this article [1]

[9]	Ginath S, Alcalay M, Ben Ami M, et al. The impact of a nationwide hands-on workshop on the diagnostic rates and management of obstetrical anal sphincter Injuries in Israel[J]. Colorectal Dis, 2020, 22(11):1677-1685. DOI:10.1111/codi.15220. Cited in this article [1]

[10]	刘瑾, 翟丽东, 李云生. 直肠阴道隔(RVS)区域的薄层断面解剖学研究[J]. 中国临床解剖学杂志, 2009, 27(6):663-664+667. DOI:10.13418/j.issn.1001-165x.2009.06.012. Cited in this article [2]

[11]	Sultan AH, Thakar R, Fenner DE. Perineal and anal sphincter trauma[M]. London: Springer-Verlag, 2007. Cited in this article [1]

[12]	Waldman R. ACOG Practice Bulletin No. 198: Prevention and Management of Obstetric Lacerations at Vaginal Delivery[J]. Obstet Gynecol, 2019, 133(1):185. DOI:10.1097/AOG.0000000000003041. Cited in this article [6]

[13]	Andrews V, Sultan AH, Thakar R, et al. Occult anal sphincter injuries--myth or reality?[J]. BJOG, 2006, 113(2):195-200. DOI:10.1111/j.1471-0528.2006.00799.x. Cited in this article [1]

[14]	Roper JC, Thakar R, Sultan AH. Under-classified obstetric anal sphincter injuries[J]. Int Urogynecol J, 2022, 33(6):1473-1479. DOI:10.1007/s00192-021-05051-y. Cited in this article [1]

[15]	Taithongchai A, Veiga SI, Sultan AH, et al. The consequences of undiagnosed obstetric anal sphincter injuries (OASIS) following vaginal delivery[J]. Int Urogynecol J, 2020, 31(3):635-641. DOI:10.1007/s00192-019-04033-5. Cited in this article [1]

[16]	Delancey JO, Toglia MR, Perucchini D. Internal and external anal sphincter anatomy as it relates to midline obstetric lacerations[J]. Obstet Gynecol, 1997, 90(6):924-927. DOI:10.1016/s0029-7844(97)00472-9. Cited in this article [2]

[17]	王乐乐, 刘妍, 周蓓, 等. 产科相关肛门括约肌损伤57例临床特征及结局分析[J]. 中国实用妇科与产科杂志, 2024, 40(5):561-565. DOI:10.19538/j.fk2024050117. Cited in this article [3]

[18]	O'Leary BD, Kelly L, Fitzpatrick M, et al. Underdiagnosis of internal anal sphincter trauma following vaginal delivery[J]. Ultrasound Obstet Gynecol, 2023, 61(2):251-256. DOI:10.1002/uog.26049. Cited in this article [1]

[19]	Anderson D. Pudendal nerve block for vaginal birth[J]. J Midwifery Womens Health, 2014, 59(6):651-659. DOI:10.1111/jmwh.12222. Cited in this article [1]

[20]	Dasrilsyah RA, Kalok A, Ng BK, et al. Perineal skin tear repair following vaginal birth; skin adhesive versus conventional suture-a randomised controlled trial[J]. J Obstet Gynaecol, 2021, 41(2):242-247. DOI:10.1080/01443615.2020.1740917. Cited in this article [2]

[21]	Bowen ML, Selinger M. Episiotomy closure comparing enbucrilate tissue adhesive with conventional sutures[J]. Int J Gynaecol Obstet, 2002, 78(3):201-205. DOI:10.1016/s0020-7292(02)00144-3. Cited in this article [2]

[22]	Defante MLR, de Souza K, Oliveira JA, et al. Continuous versus interrupted suturing for second-degree perineal tears and episiotomies:A meta-analysis of randomized trials[J]. Eur J Obstet Gynecol Reprod Biol, 2025, 314:114722. DOI:10.1016/j.ejogrb.2025.114722. Cited in this article [2]

[23]	Yeomans ER, Hoffman BI, Gilstrap LC, et al. Cunningham and Gilstrap’s Operative Obstetrics[M]. 3rd ed. New York: McGraw-Hill Education, 2017. Cited in this article [2]

[24]	Hickman LC, Propst K. Accurate diagnosis and repair of obstetric anal sphincter injuries:why and how[J]. Am J Obstet Gynecol, 2020, 222(6):580.e1-580.e5. DOI:10.1016/j.ajog.2020.02.044. Cited in this article [1]

[25]	Harvey MA, Pierce M, Alter JE, et al. Obstetrical Anal Sphincter Injuries (OASIS): Prevention,Recognition,and Repair[J]. J Obstet Gynaecol Can, 2015, 37(12):1131-1148. DOI:10.1016/s1701-2163(16)30081-0. Cited in this article [1]

[26]	Schmidt PC, Fenner DE. Repair of episiotomy and obstetrical perineal lacerations (first-fourth)[J]. Am J Obstet Gynecol, 2024, 230(3S):S1005-S1013. DOI:10.1016/j.ajog.2022.07.005. Cited in this article [1]

[27]	Fernando RJ, Sultan AH, Kettle C, et al. Methods of repair for obstetric anal sphincter injury[J]. Cochrane Database Syst Rev, 2013, 2013(12): CD002866. DOI:10.1002/14651858.CD002866.pub3. Cited in this article [1]

[28]	Duggal N, Mercado C, Daniels K, et al. Antibiotic prophylaxis for prevention of postpartum perineal wound complications:a randomized controlled trial[J]. Obstet Gynecol, 2008, 111(6):1268-1273. DOI:10.1097/AOG.0b013e31816de8ad. Cited in this article [1]

[29]	Buppasiri P, Lumbiganon P, Thinkhamrop J, et al. Antibiotic prophylaxis for third- and fourth-degree perineal tear during vaginal birth[J]. Cochrane Database Syst Rev, 2014, 2014(10): CD005125. DOI:10.1002/14651858.CD005125.pub4. Cited in this article [1]

[30]	East CE, Begg L, Henshall NE, et al. Local cooling for relieving pain from perineal trauma sustained during childbirth[J]. Cochrane Database Syst Rev, 2012,(5): CD006304. DOI:10.1002/14651858.CD006304.pub3. Cited in this article [1]

[31]	Arnold MJ, Sadler K, Leli K. Obstetric Lacerations: Prevention and Repair[J]. Am Fam Physician, 2021, 103(12):745-752. Cited in this article [2]

[32]	Eogan M, Daly L, Behan M, et al. Randomised clinical trial of a laxative alone versus a laxative and a bulking agent after primary repair of obstetric anal sphincter injury[J]. BJOG, 2007, 114(6):736-740. DOI:10.1111/j.1471-0528.2007.01331.x. Cited in this article [1]

[33]	Tucker J, Hassam T, Juszczyk K, et al. Post-repair laxative management in obstetric anal sphincter injury guidelines: A narrative review[J]. Aust N Z J Obstet Gynaecol, 2023, 63(2):204-211. DOI:10.1111/ajo.13594. Cited in this article [1]

[34]	Royal College of Obstetricians and Gynaecologists (RCOG). Green-top Guideline No. 29: Prevention and Management of Obstetric Anal Sphincter Injuries (OASIS)[M]. 3rd edition. London: RCOG Press, 2020. Cited in this article [1]

[35]	Aigmueller T, Umek W, Elenskaia K, et al. Guidelines for the management of third and fourth degree perineal tears after vaginal birth from the Austrian Urogynecology Working Group[J]. Int Urogynecol J, 2013, 24(4):553-558. DOI:10.1007/s00192-012-1982-x. Cited in this article [1]

[36]

Bergman

, Westergren Söderberg

, Ek

. Perineorrhaphy compared with pelvic floor muscle therapy in women with late consequences of a poorly healed second-degree perineal tear: a randomized controlled trial[J]. Obstet Gynecol, 2020, 135(2):341-351. DOI:10.1097/AOG.0000000000003653.

Cited in this article [1]

[37]	文燕青, 漆洪波. 多学科团队诊疗——提高救治效果[J]. 中国实用妇科与产科杂志, 2024, 40(10):978-981. DOI:10.19538/j.fk2024100105. Cited in this article [1]

[38]	蔡雨静, 周锶琦, 刘祺芳, 等. 两种盆底康复治疗模式对产后盆底肌功能修复的疗效比较[J]. 中国实用妇科与产科杂志, 2025, 41(2):245-248. DOI:10.19538/j.fk2025020119. Cited in this article [1]

[39]

Antonakou

, Papoutsis

, Henderson

, et al. The incidence of and risk factors for a repeat obstetric anal sphincter injury (OASIS) in the vaginal birth subsequent to a first episode of OASIS: a hospital-based cohort study[J]. Arch Gynecol Obstet, 2017, 295(5):1201-1209. DOI:10.1007/s00404-017-4352-6.

Cited in this article [1]

[40]	Donners JJAE, Kluivers KB, de Leeuw JW, et al. Choice of mode of delivery in a subsequent pregnancy after OASI: a survey among Dutch gynecologists[J]. Int Urogynecol J, 2017, 28(10):1537-1542. DOI:10.1007/s00192-017-3304-9. Cited in this article [1]

[41]	Karmarkar R, Bhide A, Digesu A, et al. Mode of delivery after obstetric anal sphincter injury[J]. Eur J Obstet Gynecol Reprod Biol, 2015, 194:7-10. DOI:10.1016/j.ejogrb.2015.07.019.(2026-03-10收稿) Cited in this article [1]