In plain words
The Sultan classification is the system clinicians use to grade perineal tears from childbirth. A first-degree tear involves skin and the vaginal lining only. A second-degree tear reaches the perineal muscles but not the . A involves the anal sphincter muscle, and clinicians subdivide it into 3a, 3b, and 3c by how much of the sphincter is involved. A fourth-degree tear goes through the anal lining. The grade shapes how the repair is done and what follow-up is offered. Many tears are first or second degree and heal in weeks. The grade describes the tear. It is not a judgment of how you birthed.
The deeper version
Classification of obstetric perineal trauma by depth and sphincter involvement, adopted by RCOG and ACOG. Third-degree injury (obstetric anal sphincter injury) is subdivided into 3a (less than half of the external sphincter torn), 3b (more than half), and 3c (both external and ). Occult sphincter injury can be detected on , and a substantial minority of women with third- or fourth-degree tears report later bowel symptoms in cohort series. Grading depends on examiner skill, and inter-observer agreement is imperfect.
Where it comes up
- Healing a tear or stitchesPostpartum: Your Body
- Perineal massage, tearing, and episiotomyGetting Ready for Birth
What mothers here say about Sultan classification
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Sources
- Royal College of Obstetricians and Gynaecologists — The Management of Third and Fourth Degree Perineal Tears, Green-top Guideline No. 29, 2015
- American College of Obstetricians and Gynecologists — Prevention and Management of Obstetric Lacerations at Vaginal Delivery, Practice Bulletin 198, 2018