While performing a vaginal delivery for a nulliparous woman, after successful delivery of the baby and placenta, you observe that a perineal laceration has extended to involve the external anal sphincter. All are true regarding this except?

Ans. A. It could have been avoided had you practiced a routine episiotomyPerineal injury during delivery can be prevented by proper perineal support, slow delivery of head in between contractions. Alternatively, if expulsive efforts are inadequate or expeditious delivery is needed, the modified Ritgen maneuver may be employed. With this, gloved fingers beneath a draped towel exert forward pressure on the fetal chin through the perineum just in front of the coccyx. Concurrently, the other hand presses superiorly against the occiput, this allows controlled fetal head delivery. It also favors neck extension so that the head passes through the introitus and over the perineum with its smallest diameters.American College of Obstetricians and Gynecologists has concluded that restricted use of episiotomy is preferred to routine use and episiotomy should be considered for indications such as shoulder dystocia, breech delivery, macrosomic fetuses, operative vaginal deliveries, persistent occiput posterior positions, and other instances in which failure to perform an episiotomy will result in significant perineal rupture.Repair of 3rd and 4th degree perineal tear is performed in OT under proper relaxation and anaesthesia, light and position by a senior obstetrician for best results. Torn anal sphincter is sutured using end to end anastomosis. Overlapping technique is an alternative method. Data based on randomized controlled trials do not support that this method yields superior anatomical or functional results compared with those of the traditional end-to-end method.