Obstetric injuries: injuries during childbirth

In case of pathological labor, untimely and incorrect obstetric care, birth injuries often occur: damage to the external and internal genital organs, as well as adjacent organs - the urinary tract, rectum, pelvic joints.

The causes of trauma during childbirth are divided into mechanical, associated with overstretching of tissues, and morphological, caused by their histological changes.

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Injuries to the external genitalia

Injuries to the external genitalia are observed in the area of the labia minora and clitoris. Such birth injuries are usually accompanied by bleeding, the diagnosis of which is established during examination and does not cause difficulties. In case of a rupture in the clitoris area, sutures are applied superficially, only on the mucous membrane, using a thin needle and thin suture material. Deep punctures can lead to the destruction of the superficial tissue and increase bleeding. A continuous catgut suture is applied to ruptures of the labia minora. When suturing ruptures in the area of the urethra, a metal catheter is inserted. The operation is performed under infiltration novocaine anesthesia or under epidural anesthesia continued after childbirth.

Hematoma of the external genitalia and vagina

On examination, a tumor-like formation of a bluish-purple color, swollen labia majora and minora, tense, purple in color are diagnosed. Vaginal hematomas most often occur in the lower sections. If the hematoma is small, there are no subjective sensations. If it rapidly increases, there is a feeling of pressure, distension, and burning pain. During laboratory testing, signs of anemia are determined. If the hematoma is infected, there is an increase in pulsating pain, an increase in body temperature with a decrease in the morning (hectic type of temperature), leukocytosis in the blood, and an increase in ESR. If the hematomas are small and not progressing in size, and there are no signs of infection, bed rest, cold, and hemostatic agents are prescribed. If necessary, suturing with a 2-shaped suture or suturing the hematoma with a continuous catgut suture is performed. Antibacterial therapy is prescribed according to indications. In case of large hematomas, the hematoma cavity is opened and drained, additional hemostasis is provided if necessary, tamponade is applied and treatment is carried out according to the rules of purulent surgery. Antibacterial therapy is mandatory.

Injuries to varicose veins of the vagina and vulva

A relatively rare pathology, which nevertheless poses a great danger, as it can be accompanied by profuse bleeding. Ruptures of nodes entail profuse, life-threatening bleeding, as it is extremely difficult to stop. Treatment of ruptured varicose nodes is available only to a qualified specialist. Simple suturing of the bleeding wound can only worsen the situation, as varicose veins are punctured, which increases bleeding or leads to the formation of a hematoma. If varicose nodes of the external genitalia are damaged, it is necessary to open the wound wide, separate the damaged vessels and ligate them with catgut. After bandaging and suturing the wound, apply an ice pack for 30-40 minutes.

In case of rupture of a varicose node on the vaginal wall (if it is not possible to suture and apply ligatures to the bleeding vessels), a tight tamponade of the vagina is done with a hemostatic sponge for 24 hours or more. In case of resumption of bleeding after removal of the tampon, a repeated tamponade is performed. In addition, it is advisable to perform tamponade not only of the vagina, but also of the rectum, and also to introduce ice into the vagina (for this, a rubber product is filled with water and frozen in the refrigerator).

For tamponade, gauze bandages up to 20 cm wide and up to 2-3 m long are used. Tampons should be pre-moistened with aminocaproic acid and isotonic sodium chloride solution, since a dry tampon absorbs blood well.

Ruptures of varicose nodes of the vulva and vagina can occur without damage to the mucous membrane, which leads to the formation of a submucous hematoma. In this case, a tight tamponade of the vagina is done with the possible use of ice. Only after an unsuccessful attempt to conservatively stop the bleeding, resort to surgical intervention.

Obstetric fistulas

Urogenital and gastrointestinal-vaginal fistulas lead to permanent loss of working capacity, and disturbances of sexual, menstrual and reproductive functions.

Reasons

Fistulas are formed due to prolonged compression of the tissues of the urinary tract and rectum between the walls of the pelvis and the head of the fetus. With prolonged compression of the tissues by the presenting head for more than 2 hours (after the amniotic fluid is released), their ischemia occurs with subsequent necrosis. Compression of soft tissues is usually observed with a narrow pelvis (clinically narrow pelvis), anomalies of presentation and insertion of the head, a large fetus, especially with a long anhydrous period and protracted labor.

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Clinical symptoms and diagnosis

This pathology is characterized by symptoms of urinary incontinence, gas and feces discharge through the vagina. During the examination, a fistula opening is detected using mirrors. If the diagnosis is unclear, the bladder is filled with a disinfectant solution, cystoscopy and other diagnostic methods are used.

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Treatment and prevention

Treatment of obstetric fistulas is surgical. With proper hygienic care, small fistulas can close spontaneously. Ointment tampons are inserted into the vagina and washed with disinfectant solutions. Surgical treatment is performed 3-4 months after delivery.

Prevention of obstetric fistulas involves timely hospitalization of pregnant women with post-term pregnancy, large fetus, narrow pelvis, as well as proper management of labor.