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Cervical lacerations
Last reviewed: 05.07.2025
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In primiparous women, minor ruptures of the cervix lead to a change in its shape; in multiparous women, they heal by primary intention, leaving no traces. Large ruptures are accompanied by bleeding of varying intensity.
Causes of Cervical Rupture
A certain role in the occurrence of spontaneous rupture is played by rapid and excessive stretching of tissues during fetal advancement (large fetus), limited configuration of the fetal head during post-term pregnancy, extension insertion of the fetal head, and its wide shoulder girdle.
Cervical rupture can also occur with excessive contractile activity of the uterus.
Many pathological factors contribute to cervical rupture. It is especially common in older primiparous women, in infantilism, in women in labor with a history of inflammatory diseases of the cervix and body of the uterus, during surgical interventions on the cervix for old ruptures, diathermocoagulation, diathermoconization. Cervical ruptures easily occur in placenta previa, since the cervix turns into cavernous tissue, easily torn even during a digital examination.
Violent ruptures often occur during forced or operative delivery due to incomplete dilation of the cervical os.
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Classification of cervical rupture
Ruptures of the cervix are classified as spontaneous and violent, unilateral and bilateral, linear (according to the longitudinal axis of the uterus) and crushed. A distinction is also made between rupture or necrosis of part or the entire cervix.
Classification of cervical ruptures by severity:
- I degree - rupture of the cervix on one or both sides, no more than 2 cm long;
- II degree - a rupture longer than 2 cm, not reaching the vaginal vault;
- Grade III - rupture of the cervix to the vaginal vault or with transition to its upper section.
Deeper ruptures that extend to the lower segment of the uterus or parametrium with the formation of a hematoma are interpreted as uterine ruptures.
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Treatment of cervical rupture
Ruptures of the cervix are sutured with a single-row suture immediately after delivery, using absorbable material. The first suture should be above the upper corner of the wound (in order to ligate the vessels). The remaining sutures are applied at a distance of 0.7-1 cm from the edge of the rupture through all layers. On the 6th day, the cervix is examined in mirrors. In the presence of purulent deposits or in case of suture divergence, the wound is treated daily with a 3% solution of hydrogen peroxide, furacilin (1:500), and after its cleansing - with iodine tincture or 3-5% solution of potassium permanganate. More rapid cleansing of the wound from purulent deposits is facilitated by the application of ointment dressings for 4-6 hours (Vishnevsky ointment and 10% solution of dimexide in equal proportions, syntomycin ointment).
On the 10th-12th day after delivery, if there is no purulent deposits, the cervical wounds can be re-sutured. A single-row suture is applied through all layers or a double-row suture, after refreshing the edges of the wound. The next day, with normal body temperature, the mother can be discharged.
How to prevent cervical rupture?
Prevention of cervical injuries involves the following measures:
- timely detection and treatment of inflammatory diseases of the cervix and body of the uterus;
- rational and careful management of childbirth;
- compliance with the conditions and techniques for performing obstetric operations.