Third and fourth degree perineal lacerations can produce significant long term morbidity in women undergoing childbirth. Chronic complications can include anorectal abscess, rectovaginal fistula, fecal incontinence, dyspareunia and can result in the need for operative surgical repair. Therefore, the percentage of deliveries involving third and fourth degree lacerations is a useful quality indicator of obstetrical care and can assist in reducing the morbidity from extensive perineal tears.

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• Journal of Obstetrics and Gynecology

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• Ecker J.L., et al: Is there a benefit to episiotomy at operative vaginal delivery? observations over ten years in a stable population. Am J Obstet Gyenecol, 1997: Vol.176:411-414.
• Golden W.E., Sanchez N.: The relationship of episiotomy to third and fourth degree lacerations. J of Arkansas Med Soc, 1996: Vol.92:447-448.

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