Advanced maternal age and rectal buttonhole tear in vaginal delivery: a clinical analysis of 4 cases and management experience

Perineal laceration is a common complication of vaginal delivery, among which rectal buttonhole tear—characterized by rectal wall injury with an intact anal sphincter—is relatively rare. Studies indicate that maternal age is a critical risk factor for this complication, with the probability of rectal buttonhole tear increasing significantly with advanced age. Additional contributing factors include fetal macrosomia, rapid fetal head descent, and operative vaginal delivery. Clinical management should involve prompt primary repair based on the extent and location of rectal mucosal injury, coupled with strict infection control measures, which typically yield favorable outcomes. Notably, delayed diagnosis and treatment may lead to rectovaginal fistula formation, severely impacting patients' quality of life. This article analyzes four representative cases from our institution to enhance clinicians’ awareness of age-related risks and provide evidence-based insights for prevention and management.