home Drugs What diseases cause cervical rupture? Damage to the cervix during childbirth: symptoms and causes of rupture

What diseases cause cervical rupture? Damage to the cervix during childbirth: symptoms and causes of rupture

The uterus is female organ, without which procreation would be impossible. It is in it that the development and gestation of the fetus occurs. During the birth process, the cervix plays one of the main roles. Their results directly depend on how quickly it opens. Due to the active contraction of the uterine muscles during contractions, the fetus moves towards the pharynx and is pushed out. The process of the baby passing through the cervix is facilitated by pushing.

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

Many doctors say that damage occurs when a woman pushes incorrectly without listening to instructions. medical personnel. In such cases, active attempts begin before the cervix has time to open. The result is ruptures of varying degrees.

Symptoms depend on the cause, type, stage and extent of birth injury. This can happen both during and after childbirth. On general condition and the clinical picture also reflects the presence concomitant diseases, infections, mental condition women.

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

Depending on the size of the damage, it can be massive or scanty; the woman in labor experiences bloody issues with clots. There is also abundant cold sweat, weakness, pallor. With minor damage (up to 1 cm), there are often no symptoms.

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

The uterus becomes deformed like an hourglass, swelling of the cervix, vagina and vulva appears.

When uterine rupture begins, the clinical picture is accompanied by convulsive contractions, bloody or bloody discharge from the vagina, and blood in the urine. When the rupture has already occurred, after a sudden sharp pain in the abdomen and burning, labor stops.

Due to painful and hemorrhagic shock, a woman experiences:

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

Classification of ruptures

The cervix ruptures more often in the direction from bottom to top, that is, from the outer to the inner edge of the pharynx. Organ damage can occur before, during, and after childbirth. If a rupture occurs after childbirth, the cervix is usually only slightly injured.

There are unilateral and bilateral injuries; they come in three degrees of severity. 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. In degree III, tissue divergence reaches the vaginal vault or extends to it. The most serious clinical case a rupture of the cervix extending to the body of the reproductive organ is considered.

Causes and risk factors

Birth ruptures can occur due to the woman’s fault or be the result of injury from medical forceps, as well as the result of rough palpation of the uterus and other actions of the doctor. But there are several predisposing factors.

The prerequisite for ruptures is poorly treated genital infections, which reduce the elasticity of the walls of the cervix. In addition, ruptures are almost inevitable during rapid labor.

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

With sluggish attempts labor stimulate special drugs, which also contributes to organ injuries. For women who have previously practiced gymnastics or dancing, it is typical increased tone pelvic muscles, which also contributes to ruptures due to improper management of labor.

Consequences of injury

Cervical rupture is mainly diagnosed after the birth of the baby and placenta. The doctor carefully examines the woman using mirrors to identify injuries and prevent complications.

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

Suppuration of wounds. Poor quality service medical care leads to sepsis, which can lead to removal of the uterus or death.
The appearance of a postpartum ulcer.
Spontaneous scarring, forming an inversion of the cervix.

Most often, ruptures are isolated, without transfer 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 when serious injuries can only be avoided if timely diagnosis and 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.

This makes carrying subsequent pregnancies more difficult, increased or premature appearance baby into the world.

Treatment for cervical rupture

Treatment begins immediately after ruptures are detected. The main method of eliminating damage is surgery. Lacerations are sutured using absorbable sutures under general or local anesthesia.

Sewing starts from top corner rupture, heading towards the external pharynx. If the tissue divergence has spread to the body of the uterus, a laparotomy is performed and the issue of extirpation (removal) or preservation of the organ is decided.

In case of repeated births with the presence of old ruptures, plastic surgery is performed using a special technique. Dead and scarred tissue is cut off, and when stitching, the mucous membrane is carefully stretched to form a new, more even scar and prevent future deformation.

Except surgical intervention, with heavy blood loss, intravenous infusions with hemostatic drugs and saline are indicated. 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. If you follow your 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 the attentive attitude of the mother to her health. When planning a pregnancy, it is necessary to carefully examine and treat all chronic diseases.

To prevent cervical rupture during childbirth, you should exercise special gymnastics to strengthen the vaginal muscles, take vitamins and minerals, eat right and get proper rest. It is recommended to enroll in courses for expectant mothers.

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

Proper breathing plays an important role. Timely, sufficient in depth and rhythm breathing movements reduce pain and allow you to concentrate on labor.

To reduce pain and to prevent premature pushing, painkillers are used. In order to ensure normal dilatation of the uterus, antispasmodics are prescribed.

The obstetrician leading the birth should not make sudden movements when using medical instruments or removing the fetus during breech presentation, since injury in such situations is almost inevitable.

It should be taken into account that in patients with a history of injuries reproductive organs, the risk of a repetition of the situation increases significantly.

So that subsequent births after cervical rupture take place without serious consequences, the woman should follow all the recommendations of the obstetrician-gynecologist. Coherence in the team of doctors and women in labor is the key natural birth with a favorable outcome.

Useful video: why do gaps occur during childbirth?

The uterus is an organ that is the most important link reproductive system women. It was created in such a way that it was possible to carry a child in it with maximum safety. Bottom part The uterus is called the cervix, it looks like a tube connecting the uterus to the vagina.

How the cervix works during childbirth

The opening of the external pharynx of the cervix enters the vagina, and the internal pharynx, accordingly, exits into the uterus. A path is formed between the uterus and the vagina, which is called the cervical canal. During a healthy pregnancy, the cervix is tightly closed: this protects the uterus and the fetus in it from all external threats. And only before birth can the neck protection begin to slowly open so that the baby can be born through the birth canal.

Cervical dilatation starts with internal pharynx. This is where the baby's head presses. Women who give birth for the first time are more likely to experience a slow expansion of the external pharynx. Even the beginning of labor does not always contribute to the opening of the uterus, which leads to stimulation of the birth process.

The cervix opens in several stages:

Slow period. The contractions are not strong, there is no regularity, and there is also no particular pain. The neck at this stage opens to 4 fingers.
Middle period. In the active phase of opening, contractions intensify, 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 correct behavior during childbirth, especially the final stage of dilatation of the cervix. It is very important to listen to the instructions of the doctor and midwife, not to push ahead of time, and if you push, then push correctly. But the situation when the cervix is torn does not always depend on the competent actions of the woman in labor.

Why can cervical rupture occur during childbirth?

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

Possible causes of a ruptured cervix:

Insufficient elasticity of cervical tissue due to abortion;
Scars on the cervix left after a previous birth;
Large child;
Breech presentation of the baby;
Narrow pelvis of a woman in labor;
Long labor;
Rigidity (poor uterine distension);
Early rupture of amniotic fluid.

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

How is the cervix sutured after childbirth?

Gaps are usually ranked by degree. The first degree cervical rupture is less than 2 cm, with the second degree 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 vault or simply reaches it .

The tear must be stitched 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 fatty tissue surrounding the cervix may form. Finally, the situation of blood loss by a woman in labor is dangerous. Therefore, it is necessary to sew gaps.

The cervix is sutured:

Most often with self-absorbing threads, under local anesthesia;
Sew tears from the upper corner on the way to the outer pharynx;
During repeated births, the scarred tissue is cut off, and the mucous membrane is stretched while stitching until a more even new scar is obtained, which will prevent subsequent deformation.

The suture heals quickly, but in order for the scar to form correctly, the young mother must follow all medical recommendations. Rest, including sexual rest, is needed for a certain period of time. As a rule, it reaches two months or more.

Prevention and treatment of ruptures during childbirth

If ruptures are accompanied by heavy blood loss, the woman is prescribed intravenous infusions using hemostatic drugs and saline. To prevent inflammation, your doctor may prescribe antibacterial therapy. Local antiseptics are also a mandatory part of the treatment of cervical ruptures.

Prevention of cervical injury:

Gymnastics to strengthen the vaginal muscles (during pregnancy) - effective and productive way. Suitable for both first-time mothers and multiparous women. An old seam on the neck is not an obstacle to training.
Correct breathing. Reduces the pain of childbirth, stimulates the healthy development of labor, and prevents the formation of complications.
Use of special gels. Indicated on the recommendation of a doctor for women at risk of ruptures. The gel facilitates the movement of the baby through the birth canal and reduces the risk of tissue injury.

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

What does a cervical rupture look like (video)

Don’t rush to get back on track as soon as possible: don’t bend too low, don’t make sudden movements, be careful when hygiene procedures. Take care of yourself, remember that this is a phase postpartum recovery- this is not a time of exploits, but a soft and delicate process of returning to the normal state of the body.

Cervical rupture is one of the complications of childbirth. A woman may not feel pain if the damage is not too significant, but this does not mean that this situation is not worthy of attention. Immediately after the baby is born, the doctor conducts gynecological examination, and if there are ruptures obtained during childbirth, they are stitched up.

If the stitches are not carefully applied, this can lead to a number of problems in the future:

ectropion (eversion of the mucous membrane of the cervix), which will be a constant source of inflammation, bleeding when touched, including during sexual intercourse;
there will be a threat of tissue tearing during subsequent births; in principle, such a possibility already exists with a serious degree of cervical rupture;
isthmic-cervical insufficiency - a severely damaged cervix will not be able to remain closed until the end of the pregnancy, there will be a threat spontaneous miscarriage on later And premature birth.

Such complications of cervical rupture during childbirth are very common. In order to carry a child to term, women are given stitches and the cervix is sutured, as it begins to smooth out and open ahead of time. True, this does not always help... But one way or another, childbirth after cervical rupture can and should be natural if there are no indications for surgery C-section. And the stitches are removed at approximately 37-38 weeks. Or earlier, if contractions begin, or amniotic fluid breaks.

The causes of cervical rupture during childbirth vary, sometimes they can be prevented and sometimes they cannot. Sometimes this may be due to unprofessional actions of doctors and midwives. Thus, doctors often try to manually “re-open” the cervix to the required 10 centimeters and injure the tissue.

Other reasons:

cervicitis, colpitis are infectious processes;
damage to the cervix, scars caused by abortions, diagnostic procedures, treatment of erosion and dysplasia, especially in the case of conization and diathermoelectrocoagulation - “cauterization” of erosion electric shock;
narrow maternal pelvis;
the fetus is large, which is why perineal ruptures occur during childbirth;
fast, rapid labor, especially if the baby comes out in the wrong position;
rigidity (inelasticity, poor extensibility) of the cervix - occurs in both young girls and mature women;
early pushing, a woman begins to push when the preparation of the cervix for childbirth has not been completed, there is no necessary dilation;
the use of obstetric forceps, bullet forceps, vacuum extraction of the fetus and similar manipulations;
fetal hydrocephalus.

As you can see, childbirth without ruptures is not always possible. But a woman can still do something to reduce the risk of a pathological birth. This is to pay attention to vaginal discharge - after all, it is they that are the main symptom of the inflammatory process, which can become one of the provocateurs of ruptures. Naturally, regular monitoring by a gynecologist is mandatory. And even better - visiting a school for young mothers, where they will talk about cervical ruptures during childbirth and how to prevent them. It is necessary to learn in advance proper breathing, which will help curb untimely attempts. Rarely does anyone succeed in learning this quickly while already in labor.

If a woman had complicated cervical ruptures, that is, extending to the vaginal walls, having a large area, in front of new pregnancy You need to undergo a thorough examination by a gynecologist. Often in such cases you first need to do surgical correction, this is the treatment of cervical rupture, and only then, after some time, plan conception. In this case, colposcopy should be normal. It would be useful to do an ultrasound, where the doctor can examine the scars and suggest the likelihood of problems during pregnancy.

Almost always, cervical ruptures during childbirth have some consequences. But there is no need to be upset. The main thing is to follow all the instructions of the attending physician. And give birth to a trusted specialist.

Damage to the cervix is diagnosed immediately after childbirth. Treatment is carried out by applying sutures to the tears. Full recovery after the operation occurs two months later. However, it is not recommended to become pregnant again within three years. If dystrophy is not treated, a woman may develop erosion, and even cancer of the uterus or ovaries.

Symptoms of cervical injury

The main symptom of cervical injury is bleeding. It begins immediately after tissue injury, the volume of blood loss ranges from 250 to 1000 ml. Depending on the degree of integrity violation cervical canal, the following signs are distinguished:

asymptomatic course of the disease, detection of the rupture only during examination by a gynecologist;
the woman breaks into a cold sweat, hyperhidrosis (excessive sweating) begins;
development of chronic anemia, pallor of the skin and mucous membranes;
internal and external bleeding;
drop in blood pressure and increased heart rate;
a woman’s panicky state if the rupture occurred during childbirth;
the uterus takes on an hourglass shape, swelling appears, which spreads to the cavity;
discharge of blood with clots; depending on the size of the rupture, the volume increases.

In addition to these symptoms, the doctor must determine the presence of damage to the cervix. During diagnosis in a gynecological chair, the following procedures must be performed:

palpation of the tone of the uterus, determining its shape and size;
palpating the abdomen, identifying painful areas;
examination of the cervix, establishing the severity of the rupture.

The gynecologist also asks the patient about the course of the previous pregnancy and childbirth, about the presence of venereal diseases, measures arterial pressure and pulse. The nature of the bleeding is indicated: color and volume, the presence of impurities and clots.

Most often, damage occurs during pathological childbirth, therefore, after a month or after complete isolation of lochia, it is recommended to undergo a gynecological examination.

Forms of damage

The consequences of labor are pathological and require treatment. Various shapes diseases are different clinical picture. The following types of damage to the lower segment of the uterus are distinguished:

Physiological gaps. not flexible or overly stretched, the fetus exceeds 4 kg, rapid and pathological birth, breech presentation of the fetus, narrow pelvis. Physiological damage can be predicted, so doctors will be prepared for the pathological course of labor.
Tears during surgery. In case of emergency delivery, obstetricians must perform vaginal surgery.
Injuries with complications. There is more than one rupture; they affect the isthmus, vaginal vaults, and pass into internal holes pharynx, capture the peritoneum.
Uncomplicated and asymptomatic ruptures. They also need to be treated to prevent tissue from healing improperly and scarring.

Damage is also usually divided into degrees of severity:

First degree tears up to 2 centimeters, which affect only the neck.
Second degree tears over 2 centimeters that do not reach the vaginal vault.
Third degree lacerations affecting the vaults and walls of the vagina.

After labor and expulsion of the placenta, the vagina and pharynx are examined. The tears must be stitched up. It is recommended to visit a gynecologist a month after giving birth to check the cervix for ruptures or.

Causes

Causes of injuries and damage during childbirth

Trauma and damage often occur during childbirth. The main reasons for the development of pathology:

Diseases of the cervix of an inflammatory and pathological nature, the presence of prenatal injuries:

acute or chronic cervicitis;
true cervical erosion or ectopia;
scars at the site of ruptures that formed after previous births;
frequent abortions;
treatment of erosion or dysplasia using cauterization and removal damaged areas, as a result of which the neck loses its elasticity;
removal of the cone-shaped part of the neck.

Rigidity and unpreparedness of the uterus for childbirth.

Premature discharge of amniotic fluid.

Age over 30 years, especially in the case of the first.

Damage may occur due to too long or rapid labor. For a first-time mother, labor longer than 20 hours and less than 6 hours can result in cervical injury. With repeated births, the risk increases if they last more than 16 and less than 4 hours.

If the mother has a narrow pelvis, then in the last trimester, and especially during lowering of the head, compression of the cervix is observed. Zev doesn't get enough nutrients, the elasticity and strength of the walls decreases.

If the fetus moves through the birth canal with an unbent cervical region. In this case, not only the mother suffers, but also the child.

The fetus moves along the birth canal with the pelvis forward.

Opening of the pharynx and its stretching beyond the norm. The causes of this pathology:

fetus weighing more than 4 kg;
dropsy of the brain.

Mistakes of obstetricians during childbirth.

Use of special instruments for emergency delivery: obstetric forceps, vacuum.

The medical history of a pregnant woman should describe previous births and vaginal diseases. If a woman is older or has given birth more than three times, the risk of cervical rupture increases.

Treatment

Diagnosis of damage is carried out immediately after birth. The doctor examines with the help of mirrors the presence of injuries, torn tissues and the source of bleeding. Then external palpation of the abdomen and uterus is performed. After determining the nature and shape of the ruptures, treatment begins:

The tears are closed with sutures made of self-absorbing threads.
The operation is performed under anesthesia. The patient is put into a state of sleep using intravenous injection or through an inhaler.
In case of third degree ruptures, the abdominal cavity is opened and the neck is sutured and adipose tissue around the uterus.

After the operation, sexual intercourse is prohibited for two months. Also, you should not carry heavy objects or overexert yourself during bowel movements. If the instructions are not followed, the seams may come apart.

Childbirth after a breakup

If the rupture was diagnosed in a timely manner, the damage was sutured and treated, childbirth is possible. It is optimal to wait about 3 years between pregnancies. If left untreated, the following complications are possible:

Insufficiency of the isthmus and cervix. To prevent premature birth, from 21 to 26 weeks, a pessary is inserted or sutures are placed on the internal os.
During subsequent births, the cervical canal may not open. In this case, the doctor makes an incision or prescribes an emergency caesarean section.

There are no contraindications for repeat childbirth after suturing. The main thing for a woman is to observe preventive measures and psychologically prepare for an easy birth.

Complications

Complications of cervical rupture

Deformation and disruption of the cervical mucosa is a serious disorder that must be corrected immediately. If the rupture is not sutured and treated on time, the woman experiences the following complications:

Inflammation of the cervix: cervicitis and endometritis. These processes are dangerous for women's health and at untimely treatment may cause miscarriage or severe ruptures during repeated births.
Rupture of the walls and deformation of the uterus. This complication has acute symptoms and does not allow a woman to live a full life.
A self-healed and prolonged rupture forms an inversion of the cervix. With this pathology there is a high risk of developing erosion and cancer. Chronic inflammation develops in the vagina pathological process. The woman will have to undergo regular examination and examination by a gynecologist.
With large blood loss it develops hemorrhagic shock, and subsequently the failure of the functioning of many life support systems of the body. Developing chronic anemia: weakness, dizziness, loss of consciousness, psycho-emotional disorders.
Threatening, completed and initial uterine rupture, inflammatory process in her cavity.
in the cervix or isthmus of the uterus. Blood accumulates in the cavity, which prevents normal functioning reproductive organs. This complication contributes to the fading of pregnancy in the early stages.

The pathological condition of the cervix leads to disturbances in the functioning of the uterus. When the condition is neglected, the woman feels pain in the lower abdomen, and discharge with a specific odor is observed.

Prevention

You can reduce the risk of injury by following these guidelines:

During childbirth, listen carefully to the doctor and midwife, do not push ahead of time.
Breathe correctly, do not scream while pushing.
Stay calm and don't panic, even when cutting the cervix with special forceps. The procedure is necessary to prevent tissue damage.
For better dilatation of the cervix, a woman is given antispasmodics: “No-shpa” and rectal suppositories.
To reduce discomfort during contractions, painkillers are taken. Thanks to this, the woman will not push without the doctor’s instructions.

If a woman is just planning a pregnancy, it is recommended to take preventive measures:

Pass full examination for availability infectious processes, treat all chronic diseases.
Do special gymnastics to develop the elasticity of the vagina and cervix: Kegel exercises.
Drink it. If necessary, a course of vitamin complexes.
Eat right.
Lead healthy image life: walk a lot fresh air, follow a daily routine.

During pregnancy, register with the antenatal clinic in a timely manner. Complete all examinations and visit your gynecologist regularly. If damage is inevitable during childbirth, the doctor makes an incision in the cervix. Such professional incisions are much easier to stitch and heal than lacerations, formed naturally.

Exercises to Prevent Tearing

In addition to Kegel exercises, it is recommended to do exercises to train the muscles and pelvic organs. With the help of such physical education, you can increase the elasticity of the vagina, cervix and uterus. To reduce birth injuries Gynecologists recommend doing the following exercises:

Stand straight, raise your legs with your knees bent. Try to touch your chest with your knee.
Take a chair and, holding the back of it, alternately move your legs back.
Lie on your side with your legs straight. To do the exercise, you need to tighten and tighten your buttocks and lift your straight leg up.
Plie squats. Spread your legs wide, toes pointing to the sides. Squat to right angle, lingering a little at the bottom.

Do each of the elements the same number of times on the right and left leg. During exercise, do .

Damage to the uterus and cervical canal occurs due to many reasons. The main sources of injuries and ruptures: large fetus and insufficient elasticity of the internal pharynx. Treatment is carried out immediately after delivery and removal of the baby's place.

Afterwards, the woman must be observed by a gynecologist until the sutures are completely healed and reabsorbed.

Cervical erosion during pregnancy:

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Cervical ruptures occur in both primiparous and multiparous women.

Classification. Distinguish 3 degrees of cervical rupture:

I degree - the length of the tear reaches 2 cm.

II degree - the length of the tear exceeds 2 cm, but does not reach the vaginal vault.

III degree - the cervical rupture reaches the vaginal vault and extends onto it.

Etiology and pathogenesis. Lateral tears of the cervix on both sides are physiological; they occur in all first-time mothers and subsequently indicate that the woman has given birth. These side tears can turn into tears under the following circumstances:

1) loss of elasticity of cervical tissue (infantilism, scars, inflammatory processes);

2) anomalies of labor, the process of opening of the uterine pharynx is disrupted;

3) large head sizes (large fetus, extensor insertions);

4) violent trauma during surgical delivery (obstetric forceps, vacuum extraction, fetal extraction in breech presentation).

Clinical picture. Grade I cervical ruptures are usually asymptomatic. Deeper ruptures are manifested by bleeding, which begins immediately after the birth of the child. The intensity of bleeding depends on the size of the vessel involved in the rupture: from minor to heavy. Minor external bleeding does not necessarily indicate a shallow rupture: with a rupture reaching the vaginal vault, the bleeding may be internal - into the parametrial tissue.

Diagnostics. The diagnosis of cervical rupture is made by examining the cervix using a speculum.

Treatment. Cervical ruptures are sutured with catgut sutures, preferably in two layers: one on the mucous membrane of the cervical canal, the other on the cervical muscles, starting from the upper corner of the wound. For suturing, the cervix is pulled to the entrance to the vagina using fenestrated or bullet forceps and retracted in the direction opposite to the rupture. The first suture is placed slightly above the rupture site to ensure that the cervical rupture does not extend into the fornix and further into the body of the uterus. If the upper corner of the wound on the cervix is not visually determined, you should stop examining the cervix in the speculum and perform a manual examination of the uterine cavity to determine the integrity of its walls.

Complications: bleeding, the formation of postpartum ulcers, ascending infections in the postpartum period, scars that contribute to cervical inversion (ectropion), pseudo-erosion.

Prevention. Timely preparation (“maturity”) of the cervix for childbirth in older primigravidas and in pregnant women with a tendency to carry a pregnancy to term; widespread use of antispasmodics, analgesics and labor pain relief; technically correct application of obstetric forceps, subject to all conditions; regulation of the pace of labor; prescription of lidase drugs for cicatricial changes in the cervix.

Uterine ruptures.

The incidence of uterine rupture is 0.1-0.05% of the total number of births. Among the causes of maternal mortality, uterine ruptures occupy one of the first places.

Classification.

1. By time of origin: a) rupture during pregnancy; b) rupture during childbirth.

2. According to pathogenetic characteristics.

a) spontaneous uterine ruptures: a.1) mechanical (with a mechanical obstacle to delivery and a healthy uterine wall); a.2) histopathic (with pathological changes in the uterine wall); a.3) mechanical-histopathic (with a combination of mechanical obstruction and changes in the uterine wall).

b) forced uterine ruptures: b.1) traumatic (gross intervention during childbirth in the absence of hyperextension of the lower segment or accidental injury); b.2) mixed (external influence in the presence of hyperextension of the lower segment).

3. According to the clinical course: threatening rupture, beginning rupture, completed rupture.

4. According to the nature of the damage: crack (tear); incomplete rupture (not penetrating into the abdominal cavity); complete rupture (penetrating into the abdominal cavity).

5. By localization: rupture of the uterine fundus; rupture of the uterine body; lower segment rupture; separation of the uterus from the fornix.

Etiology and pathogenesis. In the pathogenesis of uterine rupture, the combination of histopathic and mechanical factors is essential. Pathological changes in the uterine muscle are a predisposing factor, and a mechanical obstacle is a resolving factor. The features of the pathogenesis and clinical picture of the rupture depend on the predominance of one or the other.

Causes of myometrial inferiority: infantilism and malformations of the uterus (the uterus is poor in muscle tissue, less elastic), cicatricial changes due to abortions, complicated course of previous births, infections.

Clinical picture.

1.Threatened uterine rupture. If there is an obstacle to the passage of the fetus, symptoms occur in the second stage of labor. The condition of the woman in labor is restless; she complains of a feeling of fear, severe incessant pain in the abdomen and lower back, despite the administration of antispasmodics. Labor may be strong, and contractions may be frequent, intense, and painful; Outside of contractions, the uterus does not relax well. In multiparous women, labor may not be expressed sufficiently. The uterus is overstretched, the area of the lower segment is especially thin, and pain appears on palpation. With the full opening of the uterine pharynx, the border between the body of the uterus and the lower segment (contraction ring) shifts to the level of the navel, as a result the shape of the uterus changes slightly - “hourglass”, the round uterine ligaments become tense, urination is painful, frequent or absent as a result of bladder compression syndrome .

With a threatening uterine rupture, palpation of parts of the fetus is difficult due to tension in the uterus. The lower segment, on the contrary, is overstretched and thinned. If there is a disproportion in the size of the pelvis and the fetal head, a positive Vasten sign is determined. There is no advancement of the presenting part of the fetus; a pronounced birth tumor appears on the fetal head; the cervix and external genitalia swell.

2. Incipient uterine rupture. The clinic is the same as for the threatening one. The ongoing tearing of the uterine wall adds new symptoms: contractions become convulsive in nature or weak contractions are accompanied by severe pain, spotting appears from the vagina, and blood is found in the urine. Symptoms of fetal hypoxia occur, the rhythm and frequency of the heartbeat are disturbed. A pregnant woman or woman in labor complains of discomfort (heaviness, indistinct pain) in lower sections

belly. Help:

Labor should be stopped using inhalation fluorothan anesthesia or intravenous administration of b-adrenergic agonists, followed by surgical delivery. If uterine rupture threatens or has begun, childbirth is completed by cesarean section. When opening the abdominal cavity, serous effusion, swelling of the anterior abdominal wall

, bladder, pinpoint hemorrhages on the serosa of the uterus. The lower segment is thinned. Dissection of the uterus in the lower segment should be done carefully, without forcing the dilation of circular fibers, because the incision may extend into the area of the vascular bundle. The child should be removed with great care, especially with a transverse position of the fetus, a large fetus, severe asynclitism, extensor insertions, and a clinically narrow pelvis.

After removing the fetus and placenta, the uterus must be removed from the abdominal cavity and carefully examined.

Simultaneously with providing assistance to the mother, measures are necessary to revive the newborn, since in case of threatening or incipient uterine rupture due to severe hemodynamic disorders in the vessels of the uterus and fetoplacental complex, as well as as a result of the “lacing” effect of the overstretched lower segment of the uterus on the vessels of the head, neck and upper part the fetal torso, the intrauterine child develops hypoxia, which turns into asphyxia of the newborn.

3. If the premature fetus is dead, the birth can be completed with a fetal destruction operation under full anesthesia.. The moment of uterine rupture is accompanied by a feeling of strong sudden “dagger” pain, sometimes a feeling that something has burst or ruptured in the stomach. The woman in labor screams and clutches her stomach. Labor activity, which until this time was vigorous or moderate in intensity, suddenly stops. The uterus loses its outline, palpation becomes painful, and symptoms of peritoneal irritation appear.

The fetus emerges from the uterine cavity and is felt under the skin next to the uterus; the fetal heartbeat cannot be heard. Bloody discharge may appear from the genital tract. However, more often bleeding occurs in the abdominal cavity. The degree of blood loss and the nature of uterine rupture determine the picture of hemorrhagic (and traumatic) shock.

Uterine rupture may occur at the end of labor; its symptoms may not be so striking. Therefore, if during the second stage of labor bleeding of unknown cause appears, the fetus is born dead (or in a state of severe asphyxia) and the condition of the woman in labor suddenly worsens, it is urgent to carry out a thorough manual examination of the walls of the uterus.

Treatment. If a uterine rupture occurs, transection is immediately performed against the background of treatment of hemorrhagic shock and complete anesthesia. When opening the abdominal cavity, it is inspected and the loose dead fetus is removed. Then the uterus is examined, especially the vascular bundles, on both sides. The number of injuries, their location, the depth of penetration of the tears, the condition of the lower segment of the uterus are determined, paying attention to the structure of the wall. Carefully examine adjacent organs (bladder), which may be damaged by violent rupture of the uterus. The extent of the operation (suturing the rupture, amputation, hysterectomy) depends on the time since the uterine rupture, the nature of the changes in the uterine wall, the age of the woman in labor, and the presence of infection. In rare cases, it is possible to sew up the uterus. A typical operation for a uterine rupture is its extirpation. In some cases, the uterus is amputated. In case of a terminal condition of the patient, the operation is carried out in two or three stages, with an operational pause after stopping the bleeding, during which resuscitation measures to combat shock continue.

Prevention. To prevent uterine ruptures, pregnant women at risk are identified and promptly hospitalized in the antenatal department. In the hospital, they are carefully examined and a rational delivery plan is developed: a planned cesarean section or delivery through the natural birth canal. The risk group includes pregnant women: 1) with a scar on the uterus; 2) multiparous women with complicated labor; 3) with a large number of abortions or an abortion that occurred with complications; 4) with narrow pelvis, large fruit, incorrect position fetus

Uterine rupture: etiopathogenesis, classification.

Prevention.

Threatening uterine rupture: etiology, pathogenesis, diagnosis, treatment.

Beginning and completed uterine rupture: clinical picture, diagnosis, treatment.

Classification of postpartum purulent-septic diseases. Primary and secondary prevention of septic complications in obstetrics. Lactation mastitis: etiology, stages of development