ACOG Practice Bulletin: prevention, management of obstetric lacerations at delivery

  • Obstet Gynecol
  • 1 Sep 2018

  • curated by Elisabeth Aron, MD, MPH, FACOG
  • Clinical Essentials
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Takeaway

  • 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.

Recommendations

  • 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.

Study design

  • 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.

Limitations

  • Based on current scientific evidence, recommendations may change with future studies.

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