Rupture of the uterus during childbirth. Consequences of ruptures and possible complications in case of untimely therapy. Features of the treatment of uterine ruptures

The uterus is an organ that is the most important link in the female reproductive system. It is designed in such a way that with maximum safety it was possible to bear a child in it. lower part The uterus is called the cervix, it looks like a tube that connects the uterus to the vagina.

How does the cervix work during childbirth

The opening of the external os of the cervix enters the vagina, and the internal os, respectively, exits into the uterus. Between the uterus and the vagina, a path is formed, which is called the cervical canal. At healthy pregnancy the cervix is tightly closed: this protects the uterus and the fetus in it from all external threats. And only before childbirth, the neck protection can slowly begin to open so that the baby birth canal could come into being.

The opening of the neck starts from the internal pharynx. That is where the head of the baby is pressing. Women who give birth for the first time are more likely to experience a slow expansion of the external os. Not always, even the onset of labor activity contributes to the opening of the uterus, which leads to the stimulation of the labor process.

The cervix opens in several stages:

Slow period. The contractions are not strong, there is no regularity, there is no particular pain either. The neck at this stage opens up to 4 fingers.
Middle period. AT active phase the opening of the contraction intensifies, they become stronger and longer, the neck opens from 4 to 8 fingers.
Full disclosure stage. The transition from the second stage to the third is sometimes rapid. This is the most painful period, requiring maximum composure from the woman in labor.

The safety of its tissues may depend on the correctness of behavior in childbirth, especially the final stage of the opening of the cervix. It is very important to listen to the instructions of the doctor and the midwife, not to push ahead of time, and if you push, then it is correct. But not always the situation when the cervix is torn depends on the competent actions of the woman in labor.

Why can a rupture of the cervix occur during childbirth

It is believed that with age, the natural elasticity of tissues decreases. So, after 30 years, a woman experiences the first stages of tissue aging: potentially they are no longer so ready for healthy childbirth as in more young age. These are only average data, but they cannot be ignored.

Possible causes of a torn neck:

Insufficient elasticity of the tissues of the cervix due to abortion;
Scars on the neck, left over from previous births;
Large child;
Breech presentation of the baby;
Narrow pelvis of the woman in labor;
Prolonged childbirth;
Rigidity (bad distension of the uterus);
Earlier rupture of amniotic fluid.

Of course, professional errors of doctors cannot be ruled out. But all the same, it will be spontaneous forms of cervical rupture. And there are also violent forms. These include the use by doctors of instruments for emergency fetal extraction - these are either obstetric forceps or vacuum extraction of the fetus. Naturally, when several causes fall on one birth at once, the risk of rupture increases.

How is the cervix stitched after childbirth

Breaks are usually ranked by degrees. A first-degree cervical rupture is less than 2 cm; in a second-degree rupture, the rupture will exceed these 2 cm, but it does not reach the vagina by more than 1 cm. And third-degree ruptures are considered complicated, since the wound goes into the vaginal fornix or just reaches it .

The gap must be sewn up, if this is not done, it may not heal properly. And this is already fraught with cervical inversion, such consequences can become a threat reproductive health women.

If suturing is not done, a hematoma of the adipose tissue surrounding the neck may form. Finally, the very situation of blood loss by a woman in labor is dangerous. Therefore, it is necessary to sew gaps.

The cervix is sutured:

Most often, self-absorbable threads, under local anesthesia;
Breaks are sewn from the upper corner along the way to the external pharynx;
At repeated births the scarred tissue is cut off, the mucosa is stretched during stitching until a more even new scar is obtained, which will prevent subsequent deformation.

The seam heals quickly, but in order for the scar to form correctly, the young mother must follow all medical recommendations. A certain time you need peace, including sexual. As a rule, it reaches two months or more.

Prevention and treatment of ruptures during childbirth

If breaks are accompanied profuse blood loss th, a woman is prescribed intravenous infusions with the use of hemostatic drugs and saline. To prevent inflammation, the doctor may prescribe antibiotic therapy. Local antiseptics are also a mandatory item in the treatment of cervical ruptures.

Prevention of cervical injury:

Gymnastics to strengthen the muscles of the vagina (during pregnancy) is an effective and productive way. Suitable for those who give birth for the first time, and multiparous. old seam on the neck is not an obstacle to exercise.
Proper breathing. Reduces the pain of childbirth, stimulates healthy development labor activity, prevents the formation of complications.
Use of special gels. Indicated on doctor's advice for women at risk of ruptures. The gel facilitates the movement of the child through the birth canal, reduces the risk of tissue injury.

And although the described picture looks frightening, according to various estimates, from 10 to 39% of women in labor face such a pathology as cervical ruptures. Competent treatment, the implementation of all recommendations, a healthy and cold-blooded attitude to the situation will help the young mother recover as quickly as possible.

What does a cervical rupture look like (video)

Don't be in a hurry to get back in line: don't lean too low, don't do sudden movements, be careful during hygiene procedures. Take care of yourself, remember that stage postpartum recovery- this is not a time of feats, but a soft and delicate process of returning to the normal state of the body.

Anatomically, it's just component organ. It is part of the uterus - the upper genital tract of a woman, one of the main organs that are involved in the birth of a child.

Cervix- this is its lower section, which serves as a distinction between the upper and lower sections of the genital tract.

The neck itself also has certain levels of its structure, is divided into the vaginal and uterine parts, into exocervix and endocervix, there is also cervical canal, which is a wire path between the vagina and the uterine cavity.

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The cervix presents a great challenge in terms of histological structure. On it is the junction of two functionally important epithelium, it is a multilayer flat and cylindrical. It is this area that is important, since development most often occurs on it. malignant process.

Functions of the cervix

In addition, the cervix is important part in reproductive system in terms of its functions:

Rupture of the cervix

Cervical rupture is a fairly common pathology in obstetric practice, in gynecology it is much less common, and can only be associated with traumatic effects, as well as possible seals of the myomatous node.

During childbirth this pathology occurs more frequently. The risk group for cervical ruptures includes primiparous women, in multiparous cases of ruptures are much less.

The reasons

The reasons can be very different, among them are:

Such reasons are more typical with an excessive load on the internal pharynx, through which the process of childbirth begins.

But in some cases, the gap also begins with the area of the external pharynx, usually this occurs when:

Risk factors

There are a lot of them, but not always they can lead to gaps:

Types of breaks

Spontaneous breaks

Spontaneous breaks occur independently in the process natural childbirth.

Among them there are subdivisions for the causes that cause one or another rupture of the cervix:

Against the background of morphological damage to the tissue of the cervix. In inflammatory processes, connective tissue diseases, as well as the presence of previous cicatricial changes.
Against the background of a mechanical obstacle. Occur in the presence of a tumor process, as well as placenta previa.
mixed form. In which there is a combination of morphological and mechanical obstacles to the process of natural childbirth. AT this group include the birth of a large child with an insufficiently prepared cervix or in an extensor position, as well as discoordination processes in the cervix.

In turn, they can be divided into several more stages of the course of the pathological process:

Possible break.
Stage of threatening rupture. There is a process of tissue tension with impaired blood supply and spasm.
The stage of the rupture.

violent break

This type is the most dangerous.

It happens as follows:

Pure violent break. In this case, external trauma is possible, as well as delivery vaginal surgery. The most common cause in this case is vacuum extraction, as well as the imposition of obstetric forceps.
Mixed rupture of the cervix. It is formed as a result of a combination of gross mechanical interventions and the presence of morphological damage to the cervical tissue with mechanical compression.

According to the presence of complications:

Complicated. Ruptures, accompanied by the transition of the process to the vaults of the vagina, as well as possible parametric tissue. Typically, such ruptures of the neck are accompanied by severe bleeding and possible risk inflammatory process.
Uncomplicated. These are small gaps including 1 and 2 degrees.

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Degrees of cervical rupture

Currently, experts distinguish several degrees of cervical ruptures:

Such conditions are referred to serious injuries authority and require surgical intervention with the transition to laparotomy. Procedures are being carried out general anesthesia. In some cases, the assistance of specialists in a related field may be required. In the event of a rupture, a woman feels severe pain in the perineum or lower abdomen. It can be so intense that it causes pain shock.

Diagnostics

As a rule, uterine ruptures do not go unnoticed by the doctor. But in some cases, this is possible, especially since the neck is the department that may not be manifested by severe pain.

Diagnostic steps:

When diagnosing cervical ruptures severe degree consultation of anesthesiologists, therapists and surgeons is also required.

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Treatment

This is quite a serious and responsible process. The choice of tactics depends on the specialist immediately after the onset of childbirth, since delayed treatment leads to the development of serious complications.

The volume will depend on the nature of the damage, as well as the volume, complications and possible negative factors.

After assessing the extent of damage, the treatment process begins.

The main one is surgical suturing of damaged tissues:

Effects

This is enough actual topic, because it is she who can affect not only the health of a woman, but also the further possibility of childbearing.

Complications include early changes occurring in the body of a woman:

Long-term effects include:

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Increased risk of isthmic-cervical insufficiency. Which will lead to miscarriage.
Loss of protective properties, this predisposes to further development chronic inflammation in the uterine cavity.
development of infertility.
Decreased activity during sex.
Increased risk of developing a malignant process in the area of the epithelial junction.
The development of cervical inversion, as well as possible subsequent inversion of the uterus.

Prevention

it whole complex measures aimed at preventing the development of gaps. In most cases, it should be carried out in advance, but not only at the stage of pregnancy planning, but throughout the life of a woman.

Prevention measures:

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The purpose of a woman on Earth is to produce offspring. Childbirth is natural physiological process invented by nature. Many women know that the birth of a child does not always go smoothly. Complications often occur, accompanied by rupture of the cervix. The health of the expectant mother depends on how quickly the obstetrician-gynecologist notices this and takes action.

Rupture of the cervix in 98% of cases is a consequence wrong course tribal activity. Distinguish:

Independent:

Due to the weak stretching of the tissues. It is typical for primiparous women after the age of 29 years. (In the USSR they were put in the risk group of "old-timers");
Rapid labor (in primiparous up to 5 hours, in multiparous up to 2 hours);
Large child (weighing more than 4 kg);
The narrow pelvis of the woman in labor (determined by the gynecologist).

Violent, when the doctor conducts surgical measures to accelerate the birth of the fetus (by using forceps, vacuum, or pulling the fetus out by the ass).

From the degree of damage, the gap is classified into 3 degrees:

Grade 1 - tear on one side (rarely on two) no more than 1.5 cm. During childbirth, the cervix opens, its edges stretch and become thinner. Full disclosure is achieved with a diameter of 10 - 12 cm. At this moment, the woman in labor feels attempts and the midwife allows her to push. It happens that future mom early begins to push or does it not in a fight, the walls of the uterus do not withstand and are torn.

Cracks up to 0.5 cm are accompanied by weak vaginal discharge, and often they can be overlooked.

Grade 2 - from 2 cm or more, but the tear does not extend beyond the edges of the uterus. This happens if a woman with a narrow pelvis gives birth to a very large child. naturally. The fault lies with the diagnostician who carried out control measurements of the pelvis of the woman in labor and the parameters of the fetus on prenatal ultrasound.

1 and 2 degrees refer to uncomplicated ruptures.

Grade 3 - complicated rupture, more than 2 cm, affecting the vaults of the vagina or peritoneum. Accompanied by severe bleeding. A woman in labor is observed: a decrease in blood pressure, pallor of the integument, an increase in pulse, cold sweat.

It is possible to detect tissue deformation and determine its degree only after the birth of the child and afterbirth. Medical staff examines for complications. Timely undetected cracks lead to the development of infection, large blood loss or the formation of rough ones.

The reasons

Not always the cause is a violation of the flow of obstetrics. This can be facilitated by the state of the uterus itself before pregnancy or during childbirth:

The presence of one of the listed reasons in a woman in labor does not always lead to pathology. But, it requires some control.

Cervical rupture can occur at any time:

Before giving birth

A scar from previous operations in a second pregnancy can provoke a rupture, which will lead to miscarriage or premature birth with complications.

Also, a violation of the integrity of the uterus can be a consequence of an ectopic pregnancy.

To prevent such adverse effects constant competent supervision of a specialist is required.

In childbirth

Tears during childbirth are the result of too strong stretching cervical tissue. During natural childbirth or surgical exposure, there is pressure on the walls of the cervix and its damage, which in turn leads to deformation. With a deformation of 2.5 cm, the doctor must decide on an emergency. Rapid diagnosis and surgical intervention reduces the risk of consequences.

When having sex

Extremely rare, violent sex life causes cracks to form. This occurs during the sexual process using foreign objects. When injured, you feel strong pain lower abdomen, vaginal bleeding, weakness and dizziness.

Damage up to 6 mm is not always detected immediately. Weak bleeding charged to hormonal change. At the same time, there is a deterioration in well-being, accompanied by weakness, pallor of the skin and mucous membranes, increased sweating.

With a crack of more than 2 cm, appears heavy bleeding with clots, burning and pain in the perineum. Nausea occurs, decreases arterial pressure, changes heartbeat and develops pain shock. Doctors fix such symptoms immediately, and perform immediate surgery, up to an emergency caesarean section.

Diagnostics

Today, the diagnosis of complications is carried out immediately in the delivery room when examined by an obstetrician-gynecologist. When small blood secretions appear, it is determined at what period of labor this happened, and whether there was an intervention by medical personnel. An internal examination is carried out using gynecological mirrors and by palpation of the uterine cavity and abdomen for the presence of muscle tension and large gaps 3 degrees. After carrying out all the procedures and making a diagnosis, the gynecologist chooses the treatment. All consequences are eliminated by suturing. With the right operation recovery period does not require special conditions and has no complications.

Consequences of a break

Unfortunately, it is not always possible for an obstetrician to identify pathology directly in the delivery room. The consequences can be very serious:

Incorrect suturing provokes the formation of rough scars. This reduces the plasticity of the cervical tissues, causes miscarriages or premature births with next pregnancies, becomes the cause of erosion and the appearance of spotting during intercourse.

Holding surgical operation is the main treatment.

Lesions up to 0.5 cm usually heal on their own. At mild degree injuries, cracks and tears are sewn up with self-absorbable threads. Healing is fast and lasts up to 3 weeks. Treatment and use of medicines is not required. Sexual rest lasts up to 3 months.

With complex and deep wounds, spend abdominal surgery(abdominal). When the rupture passes from the uterus to adipose tissue around, with the formation of hematomas. Be sure to prescribe drugs to exclude, the occurrence of erosion and increase the immune system.

Pregnancy after cervical rupture

Pregnancy after cervical rupture is possible. This requires carrying out timely prevention(ultrasound, treatment, tests).

Any crack in the neck requires careful observation. When forming a rough seam, they can form in the small pelvis. They will interfere with ovulation and directly the onset of pregnancy. Premature birth or miscarriage can also be due to weak tissues or the presence of a scar.

At proper treatment, experts reduce these problems to a minimum. All subsequent births are carried out through C-section so as not to provoke a repeated rupture of the seam. Childbirth in this case is carried out for a period of 37-38 weeks.

Pregnancy in the cervix, its consequences

Pregnancy in the cervix (med. cervical pregnancy) is a rather dangerous pathology of the development of pregnancy.

Even 20 years ago, the removal of the uterus with this type of childbearing was the only possible method treatment. This was due to the likely profuse bleeding and without immediate surgical treatment led to the death of the pregnant woman.

Nowadays, recent studies and experiments have allowed gynecologists and surgeons to help the patient with the preservation of the reproductive organ.

Treatment is possible only under the strict supervision of a physician. A woman is prescribed special drugs depending on her physiological state.

More than 50% of women after such medical and surgical treatment can become pregnant again and give birth naturally.

The main rule of prevention is the correct course of pregnancy and childbirth, namely:

Rupture of the cervix is extremely unpleasant pathology birth outcome. But, with properly carried out prevention, timely diagnosis and competent surgical intervention, the woman will not cause much trouble.

Happy motherhood!

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Video: how to avoid tears during childbirth?

Rupture of the uterus during childbirth is still serious complication on the way to a successful delivery. It is the rupture of the uterus that entails a large blood loss has been the main cause of maternal and infant mortality at all times.

Until now, in the field of obstetrics and gynecology, physicians are working on the development unique methods to reduce the incidence of serious damage to the uterus during childbirth, as well as during the gestational period in the later stages.

On the this moment there are only special classes for pregnant women in preparation for contractions and attempts, in which the algorithm of the respiratory behavior of a woman in the delivery room is clearly drawn up, and thorough instruction is given regarding forced pulling.

Unfortunately, all this applies to natural childbirth without a burdened obstetric history, but even such favorable indications do not guarantee the exclusion of possible complications throughout the entire birth process.

Causes and classification, uterine rupture as a complication

Damage to the walls of the uterus occurs due to ineffective uterine contractions during contractions, as well as as a result of discoordinated labor, which is accompanied by either oppression or increased labor activity and useless painful contractions.

With timely and correct recognition of the situation by medical personnel, in many cases it is possible to prevent the development of pathology and minimize the risk of fetal asphyxia.

The following driving factors are attributed to the formation of gaps:

mechanical obstacles:
structural changes in the uterine wall.

Basically, damage is of a mixed nature and occurs under the influence of violent (mechanical or operational) factors.

To common reasons breaks include:

excessive stretching of the lower part of the uterus;
structural changes in the myometrium before pregnancy;
inferiority of the scar tissue fragment;
violations metabolic processes during the gestational period.

Uterine ruptures during pregnancy are classified according to a number of features that judge the nature and complexity of the pathological complication. In obstetrics, it is customary to divide the uterine rupture according to Persianinov.

Rupture implies partial or generalized destruction of the walls of the uterine cavity. With the destruction of all layers of the uterine walls, pathological destruction is called complete. When damage to the mucous tissue and muscle membrane is diagnosed without affecting the peritoneal regions, then the gap can be considered incomplete. Among all clinical cases complete break is much less common than incomplete.

Often, pathological damage occurs in upper section uterus or on its bottom, as well as within the already changed tissues (postoperative scars, damage after gynecological manipulations, abortive scars, etc.). Less often there is an anguish of healthy, full-fledged in structure, tissues.

Based on the depth and length of the gap, the condition is conditionally divided into degrees of the clinical situation:

The last degree of pathology is difficult to treat, rarely controlled even by quick resuscitation. The condition is characterized by the formation of a strong hemorrhage with unpredictable consequences for the fetus and woman. Even with the elimination of all risks to a woman's life, there is always high risk life for the health and life of the unborn baby.

When detecting uterine rupture, doctors pay attention to the nature symptomatic picture, since some types of discontinuities are characterized by individual signs and changes in patient well-being.

Symptomatic complex with uterine rupture

Clinical signs of rupture of the uterine cavity completely depend on the nature of the damage and the preceding factors. Often the symptoms are combined into a single complex, which makes it difficult to identify an unambiguous cause threatening state. Usually women experience severe pain in combination with traumatic shock, and the rupture itself is always accompanied by severe bleeding.

In some women, uterine rupture does not occur after childbirth. obvious signs, flows into latent form. Similar forms ruptures often occur with insufficient awareness of obstetricians about the pathogenesis and etiology of the appearance severe complication, or during a superficial examination of a woman in labor after delivery.

Threatening uterine rupture is recognized by the onset of rapid labor activity or its suppression, characterized by weakened contractions. The woman shows pronounced emotional anxiety, experiences severe pain. The reaction to palpation of the lower segment of the uterine cavity is painful, there is a strong tension of the rounded uterine ligaments.

In its shape, the uterus resembles an hourglass due to the anatomical displacement of the contraction ring to the navel or slightly higher, while the fetus is located in its lower segment. Any movement of the fetal head during a threatening rupture is not reliably determined, and when it is hammered along the pelvic tract, it is possible to palpate the birth tumor, which is sharply increased in size.

The main symptoms include:

Symptomatic complex with a threatening rupture, it is especially manifested with the wrong tactics of conducting the birth process. Threatening uterine rupture today is quite difficult to recognize due to a wide range painkillers that are used during childbirth, and many of the symptoms are vague.

At the time of perfect damage to the uterus, a woman experiences severe cutting pain in the pelvic area. Sensations cannot be localized precisely, since soreness covers almost the entire lower abdomen and lower back.

Pain during uterine rupture can be compared with the peak of the contraction.

After the cessation of the contraction, palpation can determine the change in the shape of the uterine cavity and part of the body of the fetus. The fetus is palpable due to its exit with the placenta into the peritoneal region. The woman's condition deteriorates sharply, there is a rapid drop in blood pressure.

The main symptoms of a breakup include:

termination of the birth process;
pain shock and large blood loss:
the possibility of palpation of parts of the fetus;
no heartbeat in the fetus.

A woman is forced to take a natural position of the body, since any movement brings unbearable pain. In this case, there is a slight discharge of blood from the vagina. In some cases, there may be no external bleeding at all. The fetus usually dies instantly.

Uterine ruptures along the scar during pregnancy in the presence of structural changes in the myometrium occur quite often. The clinical situation may occur at 31-36 weeks of gestation, when the stretching of the uterine cavity becomes more pronounced.

Signs of rupture with a complicated obstetric history include:

Histopathic transformations of the walls of the uterine cavity and the birth process often have pathological nature, characterized by an early outflow of amniotic waters, the presence of an immature cervix, discoordinated labor activity.

Delivery becomes unpredictable, and the risk of labor anomalies increases significantly. Active or excessive labor may be the answer female body on unjustified, as well as inadequate dosages of labor-stimulating drugs. Weakness of uterine contractions along with sharp increase their activities often lead to uterine rupture.

Consequences and complications, treatment and prevention

The consequences of a complicated obstetric situation in the form of uterine rupture proportionally depend on the degree of damage to the uterine tissues, on the timeliness of assistance and on the type medical events. Today, it is most easy to prevent pathology with an upcoming rupture, when, as a rupture of the cervix during childbirth, the consequences can significantly complicate a woman's health and lead to the death of the fetus.

Important consequences and complications include:

Damage to the uterus of any degree is initially subjected to suturing. Removal of the uterus often completes surgery to prevent complications of rupture III degree, as well as if it is impossible to suture the existing damage.

Regardless of the severity of the complication of the birth process, rupture is an emergency obstetric situation when it is important to quickly stop delivery with medications, such as intravenous anesthesia and provide artificial ventilation lungs to the patient (ventilator). The mother is then prepared for surgery by caesarean section.

Transportation of sick patients with a rupture is impossible, so the operation is performed where a severe obstetric situation has arisen. After the birth of the fetus, the uterine cavity is removed from the pelvic area for possible suturing or removal. With ruptures, it is important to carry out drainage therapy abdominal cavity to administer antibiotics and prevent site infection.

Along with antibiotic therapy, intensive antishock therapy and treatment of the state of blood loss (plasmaphoresis, the introduction of solutions of dextrants, compensation for the lost erythrocyte mass). Other adequate methods there is no treatment for pathological damage to the uterus.

Preventive actions:

proper examination of a woman during pregnancy;
hospitalization in a highly professional department at the slightest suspicion of pathology;
adherence to diet and drinking regimen;
prevention of weak labor activity;
special preparation of women for childbirth large fruit, narrow pelvic passage, overstretched uterus.

Specialists are obliged to most carefully monitor women with a burdened obstetric and general clinical history. If you experience any discomfort, it is important to report it to your doctor or call emergency help.

The appearance of uterine tears during pregnancy and during childbirth have fundamental differences in clinical picture and the condition of the patient. When all medical prescriptions are met, experience and skill in breathing behavior during attempts or contractions can greatly simplify natural delivery.

If bleeding occurs, premature rupture of amniotic fluid, if the condition worsens, hospitalization in a professional obstetric department is necessary.

The mother is female organ, without which it would be impossible to continue the genus. It is in it that the development and bearing of the fetus takes place. In the process of childbirth, one of the main roles is played by the cervix. Their result directly depends on how quickly its disclosure occurs. Due to the active contraction of the uterine muscles during contractions, the fetus moves towards the pharynx and is pushed out. The process of passing the child through the cervix is facilitated by attempts.

Despite the naturalness of the birth process, complications sometimes occur in obstetric practice. One of them is the rupture of the cervix during childbirth.

Many doctors claim that injuries occur if a woman pushes incorrectly without listening to the instructions of medical personnel. In such cases, active attempts begin before the cervix has time to open. The result is gaps of varying degrees.

Symptoms depend on causes, type, stage, and degree birth injury. This can happen both during childbirth and after them. On the general condition and the clinical picture is also reflected in the presence concomitant diseases, infections, mental condition women.

Injury to the cervix is accompanied by internal and external bleeding.

Depending on the size of the damage, it can be massive or scarce, the woman in labor has bloody issues with clots. There is also profuse cold sweat, weakness, pallor. With minor injuries (up to 1 cm), symptoms are often absent.

If the injury occurred during childbirth, it can be combined with a rupture of the uterus itself, which significantly changes the clinical picture. In this situation, the woman behaves restlessly, labor activity becomes excessively active and is accompanied by strong painful contractions.

The uterus is deformed by type hourglass, there are swelling of the cervix, vagina and vulva.

With the onset of uterine rupture, convulsive contractions join the clinical picture, bloody or bloody discharge from the vagina, blood in the urine appear. When the rupture has already occurred, after a sudden sharp pain in the abdomen and burning, labor stops.

Due to pain and hemorrhagic shock a woman has:

depressed state;
pale skin;
sweating;
nausea and vomiting;
drop in blood pressure;
rapid pulse.

After rupture of the uterus, the fetus can be palpated in the abdominal cavity. The complication leads to the death of the child, so his heartbeat at this moment is no longer audible.

Classification of breaks

The cervix ruptures more often in the direction from the bottom up, that is, away from the outer to the inner edge of the pharynx. Organ damage can occur before, during, and after childbirth. If there is a rupture after childbirth, the cervix is \u200b\u200busually slightly injured.

Distinguish unilateral and bilateral damage, in terms of severity, they are of three degrees. Small tears (up to 2 cm) are classified as grade I, grade II is characterized by a size of more than 2 cm, but the injury does not reach the vagina. At the III degree, the divergence of tissues reaches the vault of the vagina or passes to it. the most serious clinical case is considered a rupture of the cervix, extending to the body of the reproductive organ.

Causes and risk factors

Birth ruptures can occur through the fault of a woman or be the result of traumatism with medical forceps, as well as the result of rough palpation of the uterus and other actions of a doctor. But there are several predisposing factors.

A prerequisite for ruptures is poorly treated infections of the genital organs, which reduce the elasticity of the walls of the cervix. In addition, gaps are almost inevitable with rapid labor activity.

Active early attempts and contractions with insufficient disclosure can lead to serious ruptures not only of the cervix, but also of the body of the uterus itself.

With sluggish attempts tribal activity stimulated with special drugs, which also contributes to organ injuries. For women who have previously been involved in gymnastics or dancing, an increased tone is characteristic pelvic muscles, which also contributes to ruptures in case of improper delivery.

Consequences of injury

Rupture of the cervix is mainly diagnosed after the birth of the child and afterbirth. The doctor carefully examines the woman with the help of mirrors to identify injuries and prevent complications.

In case of untimely diagnosis, poor-quality stitching or improper care behind the seams, ruptures of the cervix during childbirth cause serious consequences:

Suppuration of wounds. Poor rendering medical care leads to or sepsis, which can be fraught with removal of the uterus or death.
The appearance of a postpartum ulcer.
Spontaneous scarring, forming an eversion of the cervix.

Most often, ruptures are isolated in nature, without moving to the body of the uterus, and occur in the second stage of labor. In such cases, the outcome is usually favorable for both the mother and the child. However, the consequences of serious injuries can only be avoided if timely diagnosis and providing emergency care.

Any untreated damage threatens the appearance, development of chronic inflammatory processes and even oncological diseases. Also, rupture of the cervix during childbirth can provoke consequences in the form of isthmic-cervical insufficiency.

Bearing subsequent pregnancies because of this is difficult, increases or premature birth of the child.

Treatment for cervical rupture

Treatment begins immediately after the discovery of gaps. The main method of repairing damage is surgery. The tears are sutured with absorbable sutures under general or local anesthesia.

Start sewing from the upper corner of the gap, heading towards the outer pharynx. If the divergence of tissues has passed to the body of the uterus, a laparotomy is performed and the question of extirpation (removal) or preservation of the organ is decided.

In case of repeated births with the presence of old tears, plastic surgery is done according to a special technique. The dead and scarred tissue is cut off, while stitching the mucous membrane is gently pulled to form a new, more even scar and prevent further deformation.

In addition to surgical intervention, with abundant blood loss, intravenous infusions with hemostatic drugs and saline are indicated. In order to prevent infection and the development of inflammation, antibiotics and local antiseptics are prescribed.

Sexual relations are prohibited in the next 2 months after suturing. Subject to the doctor's instructions, the consequences of cervical rupture will be minimal.

Prevention

Preventive measures to prevent injury to the cervix include both the professional actions of the doctor and Attentive attitude women in labor to their health. When planning pregnancy, it is necessary to carefully examine and treat all chronic diseases.

To prevent rupture of the cervix during childbirth, you should practice special gymnastics to strengthen the muscles of the vagina, consume vitamins and minerals, eat right and have a good rest. It is recommended to sign up for courses for expectant mothers.

During the birth process, a woman should carefully listen to the midwife and doctor, pushing according to their instructions.

An important role is played correct breathing. Timely, sufficient in depth and rhythm respiratory movements reduce pain and allow you to concentrate on labor.

To reduce pain and prevent premature attempts to use painkillers. In order to ensure the normal opening of the uterus, antispasmodics are prescribed.

The obstetrician conducting labor should not make sudden movements when using medical instruments or removing the fetus during breech presentation because injury in such situations is almost inevitable.

It should be borne in mind that in patients with a history of injuries reproductive organs, the risk of a recurrence of the situation increases significantly.

So that subsequent births after a rupture of the cervix pass without serious consequences, a woman should follow all the recommendations of an obstetrician-gynecologist. The coherence of actions in the team of the doctor-parturient is the key to natural childbirth with a favorable outcome.

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