From the Guidelines
Second-degree vaginal tears can lead to significant complications, including infection, persistent pain, and wound dehiscence, if not properly managed with techniques such as continuous suturing, which has been shown to reduce pain and improve outcomes 1. The most common complications of second-degree vaginal tears include:
- Infection, which may present with increased pain, redness, swelling, or purulent discharge from the tear site
- Persistent pain during sitting, walking, or sexual intercourse for weeks to months after delivery
- Wound dehiscence (reopening of the repaired tear) can occur, particularly if the repair was inadequate or if infection develops
- Some women develop scar tissue that may cause dyspareunia (painful intercourse) long-term
- Urinary or fecal incontinence can occasionally result from damage to nearby structures To prevent these complications, proper repair with absorbable sutures using a continuous suturing technique is essential, as it has been associated with less pain and reduced use of analgesia compared to interrupted suturing techniques 1. Additionally, good perineal hygiene including regular cleaning with warm water, changing pads frequently, and using sitz baths 2-3 times daily can help prevent infection. Pain management typically involves over-the-counter analgesics like ibuprofen (400-600mg every 6 hours) or acetaminophen (650-1000mg every 6 hours), and stool softeners such as docusate sodium (100mg twice daily) can help prevent constipation that could strain the repair. Patients should contact their healthcare provider if they experience increasing pain, foul-smelling discharge, fever, or opening of the wound, as these may indicate infection requiring antibiotics or other interventions, and it is crucial for the birth attendant to be well-versed in identifying and repairing perineal trauma to optimize short- and long-term outcomes 1. The technique for second-degree perineal laceration or episiotomy repair should involve anchoring the suture above the apex of the laceration in the vaginal epithelium and using a continuous, non-locking suture in a running fashion to close the vaginal epithelium and muscularis, followed by the perineal body musculature, and finally the rectovaginal fascia and perineal skin 1.
From the Research
Complications of Second-Degree Vaginal Tear
- Infection and wound breakdown are potential complications of second-degree vaginal tears, with a documented infection rate of 1.9% in one study 2.
- Compromised wound status, including increased severity of the wound or poor suturing, is associated with a higher risk of infection and wound breakdown 2.
- Women who experience second-degree vaginal tears may also experience uncertainty and a lack of trust in healthcare providers, particularly if they feel that their needs are not being met or if they are not receiving sufficient information about their care 3.
Factors Associated with Complications
- The type of suture used and the technique of suturing can affect perineal pain and wound healing 4.
- Cold gel pad therapy and treatment with natural oil on perineal wounds may also affect perineal pain and wound healing 4.
- Acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line treatment for acute pain management after vaginal delivery with perineal trauma, while epidural morphine may be recommended for severe perineal tears 5.
Long-Term Sequelae
- A poorly healed second-degree perineal tear can have long-term consequences, including pelvic floor distress and impact on quality of life 6.
- Surgical treatment, such as perineorrhaphy, may be effective in relieving symptoms related to a poorly healed second-degree perineal tear, and may be superior to pelvic floor muscle training in some cases 6.