Re: Sulcus tears

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I too had these sort of tears and the recovery has been miserable. I had retained suture material until my baby was 7 months old...the pain was unbelievable and I was repeatedly told that breastfeeding was the root of my problem.

I've spent quite a bit of time asking around and going through Medline and there doesn't seem to be a consensus on sulcus tears. I have been told that they aren't likely to occur again and that an episiotomy wouldn't necessarily stop them. Of course there is no data to back this up, so who knows if it is true?

>From what I've heard, if you had a forceps delivery last time, I would
do my best to avoid it for any subsequent births. (By that I mean if you had trouble pushing due to an epidural, thus the forceps, I would strongly consider an unmedicated birth.)

However, I had an unmedicated non-operative delivery and still ended up with them. My baby (who had a 15 inch head) descended rapidly though. I believe he may have been hung up on my tailbone and when it finally snapped, his head slammed into my pelvic floor, thus the extreme tearing.

Anyway, you have my sympathy. I wish there was more data on this as all I have is anecdotal evidence that suggests they won't occur again. To be honest, I really don’t think I could go through the tearing, the repairs and recovery a second time.

If you find anything out, please post.

Good luck, A

Here is the abstract for the article you mentioned:

Determinants of vaginal-perineal integrity and pelvic floor functioning in childbirth.

Klein MC, Janssen PA, MacWilliam L, Kaczorowski J, Johnson B

Department of Family Medicine, McGill University, Montreal, Quebec, Canada.

OBJECTIVES: Our purpose was to evaluate risk factors for severe vaginal-perineal trauma and to ascertain determinants of pelvic floor strength. STUDY DESIGN: Secondary analysis of 459 nulliparous women enrolled in a randomized controlled trial of episiotomy was carried out. In a multivariate analysis we examined the association between (1) sulcus tears, (2) third- or fourth-degree tears, and (3) pelvic floor strength and selected demographic, physiologic, pregnancy-related, and intrapartum factors. RESULTS: Unemployment and shorter second stage of labor were significant predictors of sulcus tears. Episiotomy, forceps use, and birth weight were important predictors of third- and fourth-degree tears. Whereas perineal intactness (use of episiotomy and spontaneous tears) was not influenced by exercise, a strong exercise profile was associated with fewer third- and fourth-degree tears in the presence of episiotomy. Exercise did not influence the rate of sulcus tears. A total of 35% of the variability in postpartum pelvic floor strength was explained by antepartum strength; however, we were only able to identify 5% of the factors contributing to antepartum pelvic floor strength. CONCLUSIONS: Determinants of sulcus tears appear to be present before pregnancy; third- and fourth-degree tears are related to physician management. Exercise mitigates the potential for severe trauma induced by episiotomy.

Publication Types: Clinical trial Multicenter study Randomized controlled trial

PMID: 9065189, UI: 97205461

At Mon, 19 Jun 2000, jwang, M.D. wrote: >
>I am not aware of specific factors for sulcus tears except for operative
>(forceps, vacuum) vaginal deliveries. Also, may be increased risk if
>the baby's head is looking up or sideways (normal looking down). In
>fact, there really is nothing a woman can do to prevent these tears from
>happening. If it is any consolation, like perineal tears, sulcus tears
>are less likely in subsequent deliveries.
>
>At Mon, 19 Jun 2000, Melissa wrote:
>>
>>I have been trying to gather as much info as I can about vaginal sulcus
>>tears, since I suffered extensive tearing with my first delivery and am
>>worried about future deliveries. I found a quote from an article that
>>said "Determinants of sulcus tears appear to be present before
>>pregnancy". I could not find what these determinants are (as I do not
>>have access to this article). Do any of you know what factors this
>>statement refers to?
>>
>>The statement leads me to believe that there was nothing I could have
>>done during delivery to prevent such tears. Is this true? I just want
>>to be well informed and prepared for the next time.
>>
>>Here is the info on the article in case anyone does have access to it:
>>
>>Determinants of vaginal-perineal integrity and pelvic floor functioning
>>in childbirth.
>>
>>Klein MC; Janssen PA; MacWilliam L; Kaczorowski J; Johnson B
>>
>>Am J Obstet Gynecol, 1997 Feb, 176:2, 403-10
>
>--
>J Wang, M.D
>Assitant Clinical Prof.
>Tufts University School of Medicine
>
>>**Note: Opinions expressed here are for educational purposes only
>>and, as such, do not constitute a physician-patient relationship.
>>This information is not intended to supplant the need for you to
>>consult with your physician prior to choosing therapeutic options
>>and/or interventions.>
>

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