Management of Third and Fourth-Degree Perineal Tears After Vaginal Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/079, December
          2020)

Stephan Kropshofer; Thomas Aigmüller; Kathrin Beilecke; Andrea Frudinger; Ksenia Krögler-Halpern; Engelbert Hanzal; Hanns Helmer; Susanne Hölbfer; Hansjoerg Huemer; MoenieDer Kleyn Van; Irmgard Kronberger; Annette Kuhn; Johann Pfeifer; Christl Reisenauer; Karl Tamussino; Wolfgang Umek; Dieter Kölle; Michael Abou-Dakn; Boris Gabriel; Oliver Schwandner; Gunda Pristauz-Telsnigg; Petra Welskop; Werner Bader

doi:10.1055/a-1933-2647

Geburtshilfe und Frauenheilkunde, Inhaltsverzeichnis

Geburtshilfe Frauenheilkd 2023; 83(02): 165-183
DOI: 10.1055/a-1933-2647

GebFra Science

Guideline/Leitlinie

Management of Third and Fourth-Degree Perineal Tears After Vaginal Birth. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/079, December 2020)

Artikel in mehreren Sprachen: English | deutsch

Stephan Kropshofer

¹Frauenheilkunde und Geburtshilfe, Tirol Kliniken GmbH, Innsbruck, Austria

,

Thomas Aigmüller

²Leoben Regional Hospital, Leoben, Austria

,

Kathrin Beilecke

³Klinik für Urogynäkologie, Alexianer Sankt Hedwig Kliniken Berlin GmbH, Berlin, Germany

,

Andrea Frudinger

⁴Department of Gynecology, Medical University of Graz, Graz, Austria

,

Ksenia Krögler-Halpern

⁵Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

,

Engelbert Hanzal

⁵Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

,

Hanns Helmer

⁶Department of Obstetrics and Maternal-fetal Medicine, Medical University of Vienna, Vienna, Austria

,

Susanne Hölbfer

⁷Wiener Gesundheitsverbund, Vienna, Austria

,

Hansjoerg Huemer

⁸Frauenklinik, Bethesda Spital Basel, Basel, Switzerland

,

MoenieDer Kleyn Van

⁹Midwivery, University of applied sciences, Graz, Austria

,

Irmgard Kronberger

¹⁰Visceral- und Thoraxchirurgie, Tirol Kliniken GmbH, Innsbruck, Austria

,

Annette Kuhn

¹¹Urogynaecology, Inselspital Universitatsspital Bern, Bern, Switzerland

,

Johann Pfeifer

¹²Department of Surgery, Medical University of Graz, Graz, Austria

,

Christl Reisenauer

¹³Frauenklinik, Universitätsklinikum Tübingen, Tübingen, Germany

,

Karl Tamussino

⁴Department of Gynecology, Medical University of Graz, Graz, Austria

,

Wolfgang Umek

⁵Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria

,

Dieter Kölle

¹⁴Abteilung Gynäkologie, Sanatorium Hera, Vienna, Austria

,

Michael Abou-Dakn

¹⁵Klinik für Gynäkologie, St Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany

,

Boris Gabriel

¹⁶Klinik für Gynäkologie und Geburtshilfe, Josefs Hospital Wiesbaden, Wiesbaden, Germany

,

Oliver Schwandner

¹⁷Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Germany

,

Gunda Pristauz-Telsnigg

¹⁸Abteilung Frauenheilkunde und Geburtshilfe, Landeskrankenhaus Feldbach Fürstenfeld, Feldbach, Austria

,

Petra Welskop

¹⁹Österreichisches Hebammengremium, Innsbruck, Austria

,

Werner Bader

²⁰Gynäkologie und Geburtshilfe, Klinikum Bielefeld, Bielefeld, Germany

› Institutsangaben

Abstract

Purpose This guideline provides recommendations for the diagnosis, treatment and follow-up care of 3rd and 4th degree perineal tears which occur during vaginal birth. The aim is to improve the management of 3rd and 4th degree perineal tears and reduce the immediate and long-term damage. The guideline is intended for midwives, obstetricians and physicians involved in caring for high-grade perineal tears.

Methods A selective search of the literature was carried out. Consensus about the recommendations and statements was achieved as part of a structured process during a consensus conference with neutral moderation.

Recommendations After every vaginal birth, a careful inspection and/or palpation by the obstetrician and/or the midwife must be carried out to exclude a 3rd or 4th degree perineal tear. Vaginal and anorectal palpation is essential to assess the extent of birth trauma. The surgical team must also include a specialist physician with the appropriate expertise (preferably an obstetrician or a gynecologist or a specialist for coloproctology) who must be on call. In exceptional cases, treatment may also be delayed for up to 12 hours postpartum to ensure that a specialist is available to treat the individual layers affected by trauma. As neither the end-to-end technique nor the overlapping technique have been found to offer better results for the management of tears of the external anal sphincter, the surgeon must use the method with which he/she is most familiar. Creation of a bowel stoma during primary management of a perineal tear is not indicated. Daily cleaning of the area under running water is recommended, particularly after bowel movements. Cleaning may be carried out either by rinsing or alternate cold and warm water douches. Therapy should also include the postoperative use of laxatives over a period of at least 2 weeks. The patient must be informed about the impact of the injury on subsequent births as well as the possibility of anal incontinence.

Key words

guideline - perineal tear - management perineal tear - OASI

Volltext

Referenzen

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