Characteristics and management of isolated rectal laceration during vaginal delivery

This study examined the efficacy of a quality improvement initiative aimed at decreasing both operative vaginal deliveries and rectal lacerations, while also exploring the mechanisms contributing to rectal injuries and evaluating the effects of the standardized management of rectal lacerations during vaginal deliveries.

We conducted a prospective cohort study of isolated rectal injuries during vaginal deliveries at a specialty hospital in northern China between 2023 and 2025. Patients were included if they fulfilled all three criteria: (i) isolated rectal injury during childbirth; (ii) gestational age 28 weeks or greater; and (iii) vaginal delivery. Prospectively collected data included demographic characteristics, labor and delivery details, and perioperative outcomes.

Among 24 510 vaginal deliveries, 16 isolated rectal lacerations were identified, giving an incidence of 0.065% (1/1532). Fourteen cases (87.5%) occurred in nulliparous women. Five patients (31.3%) underwent forceps delivery, and six (37.5%) had mediolateral episiotomy. Most injuries (68.8%) occurred during the day shift. During the same period, the overall rates of operative vaginal delivery and mediolateral episiotomy were 8.8% and 11%, respectively. Following a revision of obstetric policies aimed at reducing operative vaginal deliveries, the incidence of isolated rectal laceration decreased significantly (0.077% vs. 0.039%, P < 0.01). All repairs were performed by the obstetric team without the involvement of other specialties. One patient developed an anovaginal fistula near the hymen.

Isolated rectal laceration is a rare but potentially serious complication of vaginal delivery. Reducing operative vaginal deliveries might help lower its incidence, and careful rectal examination after vaginal birth is recommended to improve detection. Primary repair by an obstetric team is feasible and associated with generally good outcomes.