- The American College of Obstetricians and Gynecologists (ACOG) has updated their Practice Bulletin on obstetric lacerations.
Why this matters
- 53%-79% of women will sustain some type of laceration at the time of vaginal delivery.
- There is insufficient evidence to recommend routine episiotomy.
- The decrease in routine episiotomy may require physicians to have further training through simulation exercises.
- Third- and fourth-degree lacerations are no longer used to measure quality of care by the National Quality Forum.
- Perineal massage before and during labor may lead to a modest decrease in risk for third- and fourth-degree lacerations; warm compresses in labor may confer a modest decrease in risk for lacerations.
- Small tears of the anterior vaginal wall and labia can be left unrepaired if they are hemostatic and do not distort anatomy.
- Continuous suturing of a second-degree laceration is preferred over interrupted suturing.
- A single dose of antibiotic is reasonable in the setting of anal sphincter injury.
- Literature review and expert commentary.
- Evidenced-based guidelines for the prevention, identification, and repair of obstetric lacerations.
- Interim update (replaces Practice Bulletin 165, June 2011).
- Funding: None disclosed.
- Based on current scientific evidence, recommendations may change with future studies.