Kropshofer Stephan, Aigmüller Thomas, Beilecke Kathrin, Frudinger Andrea, Krögler-Halpern Ksenia, Hanzal Engelbert, Helmer Hanns, Hölbfer Susanne, Huemer Hansjoerg, Van MoenieDer Kleyn, Kronberger Irmgard, Kuhn Annette, Pfeifer Johann, Reisenauer Christl, Tamussino Karl, Umek Wolfgang, Kölle Dieter, Abou-Dakn Michael, Gabriel Boris, Schwandner Oliver, Pristauz-Telsnigg Gunda, Welskop Petra, Bader Werner
Frauenheilkunde und Geburtshilfe, Tirol Kliniken GmbH, Innsbruck, Austria.
Leoben Regional Hospital, Leoben, Austria.
Geburtshilfe Frauenheilkd. 2022 Dec 7;83(2):165-183. doi: 10.1055/a-1933-2647. eCollection 2023 Feb.
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. 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. 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.
本指南为阴道分娩期间发生的三度和四度会阴撕裂的诊断、治疗及后续护理提供建议。目的是改善三度和四度会阴撕裂的管理，减少近期和长期损害。本指南适用于参与护理高级别会阴撕裂的助产士、产科医生和内科医生。对文献进行了选择性检索。在一次由中立主持的共识会议期间，作为结构化过程的一部分，就各项建议和声明达成了共识。每次阴道分娩后，产科医生和/或助产士必须进行仔细检查和/或触诊，以排除三度或四度会阴撕裂。阴道和肛门直肠触诊对于评估分娩创伤的程度至关重要。手术团队还必须包括一名具备适当专业知识的专科医生（最好是产科医生、妇科医生或结直肠外科专家），该医生必须随叫随到。在特殊情况下，产后治疗也可延迟长达12小时，以确保有专科医生可对受创伤的各层进行治疗。由于端对端技术和重叠技术在处理肛门外括约肌撕裂方面均未显示出更好的效果，外科医生必须使用其最熟悉的方法。会阴撕裂一期处理时不建议造瘘。建议每天用流水清洗该区域，尤其是排便后。清洗可通过冲洗或交替使用冷热水灌洗来进行。治疗还应包括术后至少连续2周使用泻药。必须告知患者该损伤对后续分娩的影响以及肛门失禁的可能性。
