title: Differences in outcomes after third- versus fourth-degree perineal laceration repair: a prospective study.
abstract: OBJECTIVE
  The purpose of this study was to compare outcomes after third- versus fourth-degree laceration repair.
  
  
  METHODS
  Fifty-six primiparous women who sustained a third- or fourth-degree tear were enrolled at delivery and demographic and obstetric data were collected. At 6 weeks' postpartum, subjects completed a bowel function questionnaire and endoanal ultrasonography was performed. Fisher exact test and chi-square were used for statistical analysis.
  
  
  RESULTS
  Thirty-nine women with third- and 17 with fourth-degree tears were enrolled. Subjects with fourth- were more likely to report bowel symptoms (59% vs 28%, P = .03), and to demonstrate persistent combined defects of the internal (IAS) and external anal sphincter (EAS) (48% vs 8%, P = .002) than third-degree tears. Combined defects were associated with the highest risk of bowel symptoms (OR 18.7, 95% CI 3-101, P < .001).
  
  
  CONCLUSIONS
  Bowel symptoms were more common after fourth- than third-degree repair, and may be secondary to higher rates of combined defects of the IAS and EAS.
authors.affiliation: Department of Obstetrics and Gynecology, Medical College of Virginia/Virginia Commonwealth University Medical Center, Richmond, VA 23298-0034, USA. cmnichol@hsc.vcu.edu
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Nichols
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Lamb
authors.forename: Viswanathan
authors.initials: V
authors.lastname: Ramakrishnan
mesh_terms: D000328:Adult; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D019160:Endosonography; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D006801:Humans; D022125:Lacerations / Q000150:complications* / Q000503:physiopathology / Q000601:surgery; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D010502:Perineum / Q000293:injuries / Q000601:surgery; D011247:Pregnancy; D011446:Prospective Studies