vaginal laceration
Introduction
Introduction A vaginal laceration generally refers to a vaginal tearing injury caused by improper handling of itself or externally during childbirth. Perineal III degree laceration or complete perineal laceration, including vaginal laceration, perineal laceration and anal sphincter laceration, severe rupture can extend to the rectal wall, causing stool and gas incontinence. The cause of the accident is due to improper handling during the delivery process, and occasional trauma. Due to the vigorous implementation of the new method, the birth attendant properly protects the perineum and greatly reduces the incidence of perineal III degree laceration.
Cause
Cause
The cause of vaginal laceration: improper handling during childbirth, occasionally caused by trauma.
1. Childbirth is too fast:
In the primipara, the complete expansion of the vagina and perineum has a certain process, such as delivery too fast, the vagina and perineum can not adapt to the laceration.
2. The fetal head is too large or the fetal head is not in the correct position:
If the fetal head is too large and the position of the fetal head is not the same as that of the face exposed or the persistent back of the pillow, the perineal laceration may occur due to the long path length, and the shoulder is difficult to produce, that is, the fetal head is delivered, and the shoulder is difficult to deliver. May cause laceration during midwifery.
3. Perineal local anatomical factors:
The perineum is too long or too thick, or the original scar formation can cause laceration of the vagina and perineum. If the angle of the pubic bone is too small, the position of the fetal head will move downward when it is delivered. The excessive extension of the perineum is also the cause of the rupture.
4. Poor delivery technology:
If the production process is insufficiently estimated and rushed into battle, the midwife will be arbitrarily pressurized at the bottom of the palace during childbirth. When the perineum is protected, the fetal head is fully bent and the perineal tear can occur. In particular, for the primipara, a perineal incision is performed. If the incision is too small or the incision angle is too small, tearing may occur, and even a III degree laceration may easily occur.
5. Surgical production:
Ovarian vaginal surgery is for the purpose of midwifery, regardless of the forceps, fetal head aspirator, breech traction or midwifery, the operation of the fetal head should be in accordance with the requirements of normal fetus from flexion to extension, such as operation If the speed is too fast and the direction is not well controlled, it can cause laceration.
Examine
an examination
Related inspection
Gynecological routine examination of genital gynecological routine examination of transvaginal ultrasound
Diagnosis and diagnosis of vaginal laceration: vaginal probing can be diagnosed.
During the examination, the perineum disappeared and the ends of the vagina and rectum communicated. The skin behind the anus is radial wrinkles, and the sphincter is retracted to form small depressions on both sides of the anus. During anal examination, the patient is inwardly contracted to test the regulatory function of the sphincter. If the rectum is also torn, the rectal mucosa is red and turned outward.
Or a colposcopy, which uses a colposcope to magnify the vaginal and vaginal epithelium 10-40 times directly under a strong light source to observe small lesions that are invisible to the naked eye, and perform a biopsy at the suspicious site. To improve the diagnosis rate of cervical diseases.
Diagnosis
Differential diagnosis
Identification of symptoms that are easily confused by vaginal laceration:
Different from the following diseases that can cause fecal incontinence:
1, muscle dysfunction and damage: anal retraction and defecation function, is maintained by the innervation. There are several types of anal incontinence:
(1) Internal and external sphincters and levator ani muscles These muscles are slack, the tension is reduced, or they are cut, cut, or formed into large-area scars.
(2) Muscle relaxation and tension reduction caused by rectal prolapse, hemorrhoids, polyp prolapse.
(3) surgical resection of anorectal abscess, anal fistula, rectal cancer.
(4) Burns, burns, and chemical corrosion.
(5) chronic diarrhea and anorectal cancer.
2, neurological disorders and injuries: defecation is the reflex activity of the visceral autonomic nerve and the central nervous system of the brain, causing fecal incontinence has the following aspects:
(1) The nerve has a dysfunction or injury.
(2) Temporary fecal incontinence can occur after stroke, shock, or fright.
(3) Broken chest or lumbar vertebrae can damage the spinal cord or spinal nerves, which can cause paraplegia.
(4) Mucosal resection of the rectum near the anus and sensory nerve defects in the rectal wall.
(5) Mental retardation.
