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.

Fetomaternal hemorrhage (FMH) represents a relatively infrequent yet critical obstetric complication. Its subtle onset and absence of distinctive symptoms often render early detection a formidable task. This condition, if unchecked, can culminate in serious sequelae including fetal anemia, edema, and in extreme cases, fetal or neonatal demise. A variety of physiological and pathological elements inherent to pregnancy, coupled with the mother’s advanced age, can elevate the risk profile for the development of FMH. In the current paper, we present two case studies involving FMH in maternal age, and couple these with a thorough review of existing literature. Our objective is to meticulously analyze the underlying causes, diagnostic modalities, clinical presentations, and therapeutic interventions pertinent to FMH. Ultimately, our aim is to contribute a valuable resource for guiding practitioners in the accurate diagnosis and effective management of this complex obstetric challenge.