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Dramatically depicts a fourth degree episiotomy tear with an insufficient third degree repair and subsequent recto-vaginal fistula. Shows the fourth degree laceration extending from the vaginal opening through the perineal muscles and to the anus. Shows the surgical repair, in which the laceration is sutured closed while the rectal mucosa remains open. Shows the subsequent recto-vaginal fistula resulting from a perforation in the rectal mucosal layer.