Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Prevention of Obstetric Lacerations at Vaginal Delivery

Obstet Gynecol; 2018 Sep; Cichowski, et al

A single dose of antibiotic at the time of repair is reasonable in the setting of obstetric anal sphincter injuries, according to updated clinical management guidelines from the American College of Obstetricians and Gynecologists (ACOG) on the prevention and management of obstetric lacerations at vaginal delivery. The practice bulletin has been updated to reflect a limited, focused change to align with ACOG’s practice bulletin on Use of Prophylactic Antibiotics in Labor and Delivery. Among the other (Level A) recommendations:

  • Because application of warm perineal compresses during pushing reduces the incidence of third-degree and fourth-degree lacerations, obstetrician–gynecologists and other obstetric care providers can apply warm compresses to the perineum during pushing to reduce the risk of perineal trauma.
  • Restrictive episiotomy use is recommended over routine episiotomy.
  • For full-thickness external anal sphincter lacerations, end-to-end repair or overlap repair is acceptable.


Prevention and management of obstetric lacerations at vaginal delivery. ACOG Practice Bulletin No. 198. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;132:e87–102.