birth canal laceration
Introduction
Introduction During pregnancy, the soft birth canal undergoes a series of changes to accommodate childbirth, such as tissue becoming soft, increased elasticity and a degree of stretch. Despite these changes, the degree of expansion required for the fetus to be delivered through the birth canal is greater. Most women, especially primiparas, may experience varying degrees of damage to the cervix, vagina, and perineum during childbirth. The so-called birth canal laceration here refers to the laceration of the soft birth canal during childbirth. The general perineal laceration can be divided into four degrees, the first level of laceration is a minor laceration, relatively rare in the primipara, mostly through the mother. The second-stage laceration is a moderate degree of laceration. Most pregnant women belong to this kind of laceration. It is usually easy to suture. The third-order laceration refers to the anal sphincter being broken. If it is not repaired, it will cause future incontinence. A well-trained obstetrician will not let this happen. The fourth-order laceration refers to the splitting of the anus, usually when the child is overweight, but if carefully sutured, most pregnant women will not have any sequelae. Another type of laceration of the birth canal refers to a laceration of the vagina, which means that the perineal wound extends into the vagina, sometimes quite severe, or even split two or three. The main cause of vaginal laceration is that the birth canal can not be properly expanded, the fetus is relatively large relative to the birth canal, and the use of a vacuum aspirator or forceps to suck out or pull out the fetus can cause severe laceration of the vagina. Therefore, if it is predicted that the child is not easy to give birth from the vagina, or if the childbirth will cause severe vaginal laceration, or do not force, caesarean section production may be a better choice.
Cause
Cause
The uterus contraction force is too strong, the labor process is progressing too fast, and the fetus is too large, which can often cause laceration of the cervix and/or vagina when the fetus has not been delivered. Improper protection of the perineum, improper operation of midwifery can also cause perineal vaginal laceration. When the perineum is cut open, the small fetus is prone to severe perineal laceration. Premature perineal lateral incision can also cause excessive bleeding in the incision.
The severe vaginal laceration of the perineum can be extended to the sacral, paravaginal space, and even deep into the pelvic wall. The deep vaginal area of the vagina is severely torn, and the hematoma can be extended upward into the broad ligament.
During the delivery process, a slight laceration of the cervix is almost inevitable. Usually, the laceration is shallow and there is no obvious bleeding, and no diagnosis of cervical laceration is made. Cervical laceration with more bleeding occurs when the fetus passes too fast through the cervix that has not yet been opened. In severe cases, the vaginal fistula may be involved downwards, and the upper uterus may reach the lower uterus and cause massive bleeding.
Examine
an examination
The laceration of the birth canal can be divided into two types: laceration of the vagina and laceration of the perineum. The perineum mainly refers to the tissue between the vaginal opening and the anus. In terms of personal experience, in addition to the mother weighing less than two thousand grams or the mother is already a few births, the perineum must be split. The advantage of perineal incision is that the wound is neat and easy to suture, and the perineal wound will be more beautiful. Therefore, it is recommended that most women should perform perineal incision.
Diagnosis
Differential diagnosis
Each pregnant woman may have different degrees of laceration of the birth canal, but if the fetus is too large, the production of forceps, the obvious edema of the birth canal or varicose veins, dystocia, emergency, the last birth of the laparotomy, and the attempt to vaginal producers, Will increase the chance of severe laceration.
When the doctor examines the perineal incision, if the bleeding point is found not only in the perineum, and the uterus contraction is good at this time, it is highly suspected that there are other lacerations in the upper part of the birth canal. The laceration of the birth canal is sometimes very fast, and blood transfusion is required before the wound is sutured. Sometimes, although the appearance of the wound does not bleed after suturing, a hematoma is formed deeper in the laceration, which may cause the mother to have unstable signs of life or swelling and pain in the postpartum ward.
The laceration of the birth canal can be divided into two types: laceration of the vagina and laceration of the perineum. The perineum mainly refers to the tissue between the vaginal opening and the anus. In terms of personal experience, in addition to the mother weighing less than two thousand grams or the mother is already a few births, the perineum must be split. The advantage of perineal incision is that the wound is neat and easy to suture, and the perineal wound will be more beautiful. Therefore, it is recommended that most women should perform perineal incision. The general perineal laceration can be divided into four degrees, the first level of laceration is a minor laceration, relatively rare in the primipara, mostly through the mother. The second-stage laceration is a moderate degree of laceration. Most pregnant women belong to this kind of laceration. It is usually easy to suture. The third-order laceration refers to the anal sphincter being broken. If it is not repaired, it will cause future incontinence. A well-trained obstetrician will not let this happen. The fourth-order laceration refers to the splitting of the anus, usually when the child is overweight, but if carefully sutured, most pregnant women will not have any sequelae. Another type of laceration of the birth canal refers to a laceration of the vagina, which means that the perineal wound extends into the vagina, sometimes quite severe, or even split two or three. The main cause of vaginal laceration is that the birth canal can not be properly expanded, the fetus is relatively large relative to the birth canal, and the use of a vacuum aspirator or forceps to suck out or pull out the fetus can cause severe laceration of the vagina. Therefore, if it is predicted that the child is not easy to give birth from the vagina, or if the childbirth will cause severe vaginal laceration, or do not force, caesarean section production may be a better choice.
