Repair of a fourth-degree obstetric laceration

(A) Fourth-degree laceration.
(B) The torn anal mucosa is repaired using a running stitch, but interrupted stitches are also acceptable.
(C) The internal anal sphincter should be properly identified and repaired as a separate layer.
(D) The external sphincter is then identified and repaired. The repair consists of either end-to-end or overlapping plication of the disrupted external anal sphincter and capsule using interrupted or figure-of-eight sutures.