Williams and Chames identified risk factors for predicting breakdown of a perineal laceration repair done following a vaginal delivery. These can help identify a patient who may benefit from closer monitoring and more aggressive management. The authors are from the University of Michigan in Ann Arbor.


Factors associated with increased risk:

(1) mediolateral episiotomy

(2) operative delivery if mediolateral episiotomy performed

(3) third or fourth degree laceration

(4) presence of meconium

(5) second stage of labor > 60 minutes



• Operative delivery involved low or outlet vacuum or forceps.


Factors associated with decreased risk:

(1) previous vaginal delivery (unless second stage of labor > 60 minutes, page 757)

(2) operative delivery together with midline episiotomy


The authors noted that early repair of the laceration could be done successfully if there was an intensive program of wound irrigation, debridement and sitz baths over a period of 4-10 days.


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