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Tears of the cervix
Last reviewed: 23.04.2024
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In primiparas, minor cervical ruptures lead to a change in the shape of the cervix, they heal with a primary tension in re-birth, leaving no traces. Large gaps are accompanied by bleeding of varying intensity.
Causes of cervical rupture
In the occurrence of spontaneous rupture, a certain role is played by rapid and excessive stretching of the tissues during fetal progression (large fetus), limited fetal head configuration with a delayed pregnancy, extensor insertion of the fetal head, and its broad humeral girdle.
A rupture of the cervix can also occur with excessive contractile activity of the uterus
The rupture of the cervix is facilitated by many pathological factors. Especially often it occurs in the aged primiparas, with infantilism, in parturients with inflammatory diseases of the cervix and the body of the uterus in anamnesis, with surgical interventions on the cervix for old ruptures, diathermocoagulation, diathermoconization. It is easy to break the cervix with a placenta previa, as the cervix becomes a cavernous tissue, easily tearing even during the finger research.
Violent ruptures are often found in forced or operative delivery on the background of incomplete opening of the uterine throat.
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Classification of cervical rupture
Tears of the cervix are classified into spontaneous and violent, one- and two-sided, linear (respectively longitudinal axis of the uterus) and pomozhennye. There are also separation or necrosis of part or the entire cervix.
Classification of cervical ruptures by severity:
- I degree - cervical rupture from one or both sides of a length of not more than 2 cm;
- II degree - a gap longer than 2 cm, not reaching the arches of the vagina;
- III degree - rupture of the cervix to the vaginal vault or to the upper part of the vagina.
Deeper gaps that go to the lower segment of the uterus or parametric fiber with the formation of a hematoma are treated as uterine ruptures.
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Treatment of cervical rupture
Tears of the cervix are sewn with a single-seam suture right after delivery, using a resorbable material. The first seam should be above the upper corner of the wound (for the purpose of vascular dressing). The remaining seams are applied at a distance of 0.7-1 cm from the edge of the rupture through all the layers. On the 6th day, the cervix of the uterus is examined in mirrors. In the presence of purulent raids or in case of seam divisions, the wound is treated daily with 3% hydrogen peroxide solution, furacilin (1: 500), and after its purification - iodine tincture or 3-5% potassium permanganate solution. The faster cleansing of the wound from purulent raids contributes to the imposition of ointment dressings for 4-6 hours (Vishnevsky ointment and 10% solution of dimexide in equal proportions, synthomycin ointment).
On the 10-12th day after childbirth in the absence of purulent raids, it is possible to re-suture the wounds of the cervix. Apply a single-row seam through all the layers or double-row, before refreshing the edges of the wound. The next day at normal body temperature, the woman in the hospital can be discharged.
How to prevent cervical rupture?
Prevention of cervical injury involves the following activities:
- timely detection and treatment of inflammatory diseases of the cervix and the body of the uterus;
- rational and careful management of childbirth;
- compliance with the conditions and techniques for performing labor-delivery operations.