症例 challenge · Surgical approach decision / Obstetrics / Pelvic floor · teaching

Obstetric Third/Fourth-Degree Perineal Tear (OASIS) · Graded Repair · case challenge

Given a case, work through the care pathway step by step; the tool checks each choice and scores you. Decisions and basis are taken from this site's reviewed care pathways.

← View the full flowchartBased on RCOG GTG-29 / SOGC 457

Case #1Surgical approach decision / Obstetrics / Pelvic floor

📋 Case data

Systematic exam (including rectal exam) and gradingRectal buttonhole tear (sphincter intact)

Data is taken from this pathway's reviewed node text. Work through the pathway step by step.

Step 1 / 1 · Systematic exam (including rectal exam) and grading

Sultan/RCOG grade?

💡 Grades: 3a EAS tear <50% thickness; 3b ≥50% thickness (full-thickness); 3c both EAS and IAS torn; 4th degree involving the anal epithelium. There is also a rectal buttonhole tear (isolated rectal mucosa tear, sphincter intact). Repair must be in theatre, good lighting, regional/general anesthesia, by a trained operator. Postoperative routine: broad-spectrum antibiotics, laxative (lactulose; avoid constipating regimens), adequate analgesia, pelvic floor physiotherapy, perineal clinic follow-up, and counselling on mode of next delivery.

For teaching. Decisions and their basis are taken from this site's reviewed care pathways; for licensed clinicians/trainees, this does not replace clinical judgment or local protocols.