Obstetrical injuries: trauma at delivery

In the case of abnormal delivery, untimely and incorrect delivery of obstetrical care, trauma often occurs during childbirth: damage to the external and internal genital organs, as well as adjacent organs - the urinary tract, rectum, articulations of the pelvis.

The causes of trauma during childbirth are divided into mechanical, associated with the overextension of tissues, and morphological, due to their histological changes.

[1], [2], [3], [4], [5]

Injuries to external genital organs

Injuries to the external genitalia are observed in the region of the labia minora and the clitoris. Such trauma during childbirth, as a rule, is accompanied by bleeding, the diagnosis of which is established upon examination and does not cause difficulties. At a rupture in the clitoral area, the seams are superimposed superficially, only on the mucous membrane, using a thin needle and thin suture material. Deep injections can lead to destruction of the superficial tissue and increase bleeding. On the tears of the labia minora, a continuous catgut suture is applied. When the ruptures are closed, a metal catheter is inserted into the urethra. The operation is performed under infiltrative novocaine anesthesia or under epidural anesthesia that continues after delivery.

Hematoma of external genitalia and vagina

Upon examination, a tumor-like formation of blue-purple color is diagnosed, swollen large and small labia, tense, crimson color. Hematomas of the vagina occur more often in the lower parts. At small sizes of a hematoma there are no subjective sensations. In the case of their rapid increase there is a feeling of pressure, bursting, burning pain. During the laboratory study, signs of anemia are determined. When the hematoma is infected, there is a marked increase in pain of a pulsating nature, an increase in body temperature with a decrease in morning temperature (a hectic type of temperature), a leukocytosis in the blood, an increase in ESR. With small and not progressing in size hematomas, the absence of signs of infection is prescribed bed rest, cold, haemostatic. If necessary, sewing with a 2-suture or sewing with hematomas with catgut continuous seam. According to the indications, antibacterial therapy is prescribed. With large hematomas, an opening and drainage of the cavity of the hematoma is performed, if necessary, additional hemostasis, plastered and treated according to the rules of purulent surgery. It is mandatory to prescribe antibacterial therapy.

Injuries to varicose veins of the vagina and vulva

Relatively rare pathology, which is still a great danger, as it can be accompanied by heavy bleeding. The rupture of the nodes entails an abundant, life-threatening bleeding, since it is extremely difficult to stop. Treatment of varicose veins ruptures is available only to a qualified specialist. Simple stitching of bleeding brine can only worsen the situation, since varicose veins are pierced, which increases bleeding or leads to the formation of a hematoma. In case of damage to varicose nodules of the external genitalia, it is necessary to open the wound widely, to separate the damaged vessels and to bandage them with catgut. After bandaging and suturing the wound, a bubble with ice is applied for 30-40 minutes.

If the varicose vein ruptures on the vaginal wall (if it is not possible to patch and apply ligatures to bleeding vessels), make a tight tamponade of the vagina 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 a tamponade not only of the vagina, but also of the rectum, and also introduce ice into the vagina (for this purpose, fill with a rubber product and freeze in the refrigerator).

Tamponades use gauze bandages up to 20 cm wide and 2-3 m long. Tampons should be moistened with aminocaproic acid and isotonic sodium chloride solution, since a dry swab absorbs blood well.

Disruptions of varicose veins of the vulva and vagina can occur without damage to the mucosa, which leads to the formation of submucous hematoma. In this case, make a tight tamponade of the vagina with possible application of ice. Only after an unsuccessful attempt at conservative hemorrhage stops is it resorted to surgical intervention.

Obstetric fistulas

Genitourinary and intestinal vaginal fistulas lead to permanent loss of ability to work, violations of sexual, menstrual and generative functions.

Causes

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 with the head for more than 2 hours (after the lithium of amniotic fluid), their ischemia followed by necrosis. Soft tissue compression is usually observed with a narrow pelvis (clinically narrow pelvis), anomalies of presentation and insertion of the head, a large fruit, especially with prolonged anhydrous period and prolonged labor.

[6], [7], [8], [9],

Clinical symptoms and diagnosis

This pathology is characterized by the symptoms of urinary incontinence, the escape of gases and feces through the vagina. In the course of the study, a fistulous opening is detected with the help of mirrors. With an unclear diagnosis, the bladder is filled with a disinfectant solution, cystoscopy and other diagnostic methods are used.

[10], [11], [12]

Treatment and prevention

Treatment obstetric fistulas operative. Subject to proper hygienic care, small fistulas can close spontaneously. In the vagina injected ointment swabs, washed with disinfectant solutions. Operative treatment is carried out 3-4 months after childbirth.

Prevention of obstetric fistula formation is the timely hospitalization of pregnant women with a pregnant pregnancy, a large fetus, a narrow pelvis, and in the correct management of labor.