Risk factors and management of obstetric perineal injury

Perineal injury sustained during childbirth is a major aetiological factor in the development of perineal pain, sexual dysfunction, prolapse and disturbance in bowel and bladder function. Preferential use of the vacuum extractor, restricting the use of episiotomy, repair of anal sphincter rupture by a trained doctor and selective caesarean section in these women can be beneficial in preventing complications. More focused training of midwives and doctors in perineal and anal sphincter anatomy and repair is needed to minimize the morbidity associated with inadequate repair and missed tears. Future research must address ways to predict and minimize severe perineal injury, and the management of subsequent pregnancies following anal sphincter injury.