1. Irrigate the laceration with sterile saline solution. Identify the anatomy, including the apex of the rectal mucosal laceration.

2. Approximate the rectal submucosa with a running suture using a 3-O chromic on a GI needle extending to the margin of the anal skin.

3. Place a second layer of running suture to invert the first suture line, and take some tension from the first layer closure.

4. Identify and grasp the torn edges of the external anal sphincter capsule with Allis clamps, and perform a repair as for a third-degree laceration. Close the remaining layers as for a second-degree laceration.

5. A low-residue diet, stool softeners, and sitz baths are prescribed post-partum.

References: See page 184.

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