A 20-year-old G1 at 41 weeks has been pushing for 2½ hours. The fetal head is at the introitus and beginning to crown. It is necessary to cut an episiotomy. The tear extends through the sphincter of the rectum, but the rectal mucosa is intact.
How should you classify this type of episiotomy?A. First-degree
A first-degree tear involves the vaginal mucosa or perineal skin, but not the underlying tissue. In a second-degree laceration, the underlying subcutaneous tissue (the fascia and muscles of the perineal body) is also involved, but not the rectal sphincter or rectal mucosa. Third degree lacerations involve the anal sphincter. A fourth-degree laceration involves a tear that extends into the rectal mucosa to expose the lumen of the rectum.