home Adviсe Old cervical rupture. The degree of this pathology of the cervix. Is it possible to avoid complications?

Old cervical rupture. The degree of this pathology of the cervix. Is it possible to avoid complications?

The cervix plays very important role during the birth process. In fact, the beginning of the second stage of labor - pushing - depends on its opening. During contractions (when the muscles of the uterus actively contract), a uterine os (circle) forms on the cervix, through which the fetus will move out of the uterus. The diameter of this circle should reach 10-12 cm, and only after this the woman enters the second stage of labor: she begins to push and “push out” the fetus.

In practice, everything can go wrong. Attempts come, but the cervix is not dilated. If a woman begins to push, the cervix naturally cannot withstand the pressure and ruptures. This is exactly what it is common cause ruptures, so many doctors claim that mothers themselves are to blame for the cervix breaks. You need to push according to the instructions of the medical staff. But is everything really like that? Let's figure it out.

Causes of cervical rupture

There are several reasons for this birth pathology. At the same time, observations show that most often ruptures occur in primiparas, and they can be varying degrees(there are 3 degrees of ruptures), spontaneous and violent (as a result of surgery).

So, the reasons:

premature attempts when the cervix has not opened to the desired size;
decreased elasticity of the cervix;
women;
cervical surgery;
presence of scars after abortion or childbirth;
infections in the uterus;
childbirth in ;
surgical delivery with forceps, etc.

It cannot be said that in all these cases cervical ruptures necessarily occur. Most often, the cervix ruptures if several factors are present at the same time. For example, large fetus and incomplete dilation. In any case, the phenomenon, although unpleasant, is often inevitable. According to some data, in 50% of cases, childbirth ends in ruptures of both the perineum and the cervix.

Possible consequences

The consequences of this pathology depend primarily on the severity of the rupture and the assistance provided. Diagnosing a cervical rupture is quite simple. Usually, if it occurs, the woman begins to bleed, but not always. In modern maternity hospitals, every woman is examined, and doctors use mirrors to detect postpartum pathologies on the cervix. Any ruptures (complicated or not) are sutured with Kedgood. These seams do not require special care. You just need to abstain from sexual relations for 2 months.

If the sutures are applied incorrectly (or a cervical rupture is not detected), then the woman is at great risk. unpleasant consequences. The vaginal and uterine area may become inflamed; a damaged and improperly healed cervix may not be able to withstand subsequent births and even pregnancies, resulting in miscarriages or.

Well, the most dangerous complication unsutured rupture is cervical inversion, which in the future may even cause oncological diseases.

Prevention

The main prevention of cervical ruptures is correct flow childbirth, which largely depends on the woman in labor. Doctors strongly recommend listening to your body and the advice of obstetricians. At first labor activity it is important to endure the first periods of pushing until full dilation (that is, do not push) and breathe correctly.

It is also recommended to use for prevention antispasmodics, which will facilitate the opening of the cervix, if necessary, anesthetize labor, and most importantly, try to provide for possible infringement of the cervix.

Have an easy birth without any ruptures!

Especially for- Tanya Kivezhdiy

Cervical rupture is an injury that is accompanied by severe violations of the integrity of the walls of this organ. The gap is considered one of the most severe complications in obstetrics. It can be spontaneous (appearing without outside intervention) or violent (arising under the influence external factors). Separately, there is a complete rupture, when the entire cervix is damaged, and an incomplete rupture, when the endometrium and myometrium are damaged, but the perimeter remains intact. It is also customary to distinguish three degrees:

1st degree – damage does not exceed 2 cm in length.
2nd degree - the wound does not extend to the vaginal wall, but is deeper than 2 cm.
3rd degree - damage extends to the vaginal vaults.

Experts differentiate between complicated and uncomplicated cervical rupture. In the first case, the lesion belongs to the first or second degree. In the case of a complicated rupture, it extends to the vaginal vault, reaches the internal uterine os, and involves the peritoneum or parametrium. For any rupture, a woman needs qualified medical care.

Causes

Rupture of the cervix occurs due to insufficient dilatation during pushing. The muscles cannot withstand such tension and tear. Among the reasons are:

Diseases of the cervix: cervicitis, erosion, scars, inflammatory and degenerative processes.
Compression of the cervix by the fetal head and the pelvic bone ring.
Overstretching of the edges of the uterine pharynx due to large fetuses or when it is in an extension position.
Rigidity of the cervix.
Delivery operations.
Long or quick labor.
Premature rupture of amniotic fluid.
The weight of the fetus is more than 4 kg.

Cervical rupture and erosion

Cervical rupture most often occurs in women who give birth for the first time. If the wound cavity is not completely sutured, the untreated area begins to slowly heal. This leads to erosion and deformation of the cervix, causing the mucous membrane cervical canal turn out. During an intravaginal examination, the doctor sees normal columnar epithelium that is turned outward.

Symptoms

Most a clear sign cervical rupture is bleeding. Usually it is abundant, the volume of discharge is 300-1000 ml. However, put accurate diagnosis It is impossible to rely on this symptom alone, since not in all cases the rupture is accompanied by bleeding from the vagina. Also, integrity damage up to 1 cm may not show any signs. A cervical rupture is indicated by:

Increased sweating cold sweat.
Pallor skin and mucous membranes in the vagina.
Pain in the lower abdomen.
Dizziness, loss of consciousness due to pain.
Swelling of the uterus, which slowly spreads to the entire perineal area.
Difficulty urinating.
Deterioration of the fetus' condition.

Diagnostics

In most cases, the presence of a rupture can be suspected by bleeding. First, the gynecologist must examine the cervix using medical mirrors. If a tear is detected, it is immediately sutured. To diagnose, the doctor must:

Collect a detailed medical history: find out how long ago the bleeding began, what contributes to an increase in the intensity of discharge, what type of discharge the woman has gynecological diseases, number and characteristics of pregnancies and childbirth.
Conduct objective research– visual examination of the woman, palpation of the abdomen and uterus, measurement blood pressure and heart rate.
Conduct a vaginal obstetric examination - using your hands, the doctor will determine the size, shape and muscle tension of the uterus, and examine its walls.
Examine the cervix using wide speculums that are inserted into the vagina.

Treatment

The basis of treatment is surgical correction. If there is no bleeding, doctors close the rupture with self-absorbing sutures. The operation is performed under general anesthesia, the cervix is brought closer to the vaginal outlet using bullet forceps and retracted in the opposite direction. After this, the doctor places stitches just above the tear through all layers of the cervix except the mucous membrane. If the lesion is extensive, autopsy may be required. abdominal cavity, in this case the operation is called transection. It is usually indicated when the parametrium is ruptured and hematomas form there.

Complications and consequences

In most cases, cervical rupture does not lead to serious consequences. After complete healing, the woman returns to to the usual way life. If the rupture was discovered late or was not completely sutured, the woman may experience a number of complications. Among them are:

Rupture of the uterus or disruption of the integrity of its walls.
Formation of a hematoma in the fatty tissue around the uterus.
Inflammatory processes in the cervix.
Hemorrhagic shock due to loss of blood.
Disturbances in the reproductive system.
Cervical inversion, which increases the likelihood of cancer and erosion.

An incompletely sutured cervical rupture can cause complications. This leads to future miscarriage and isthmic-cervical insufficiency. Pathology also provokes the formation of inflammatory and precancerous diseases. Due to the formation of scars at the site of the rupture, a woman may have problems with reproductive system, the quality of sexual life decreases.

Prevention

Prevention consists of proper management of labor, timely and careful delivery, which should be carried out in obstetric conditions. It is strictly forbidden to extract the fetus if the throat is not open enough. If the doctor sees that it is impossible to do without applying forceps due to incomplete opening of the pharynx, then it is necessary to cut it in both directions using surgical scissors.

To prevent recurrent cervical rupture, a woman should abstain from sex for 2 months.

Ignoring this recommendation leads to rupture of the applied sutures, resulting in bleeding and the formation of erosion. You can plan a pregnancy only after complete deliverance from the consequences of a breakup. Doctors recommend that at least 2 years pass from the moment of uterine surgery to conception. Otherwise, there is a high risk of ectopic pregnancy or other complications.

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 birth trauma. This can happen both during and after childbirth. On general condition And 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 profuse cold sweat, weakness, and 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 the 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 is stimulated 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 and development of chronic inflammatory processes and even cancer. 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.

At repeated births with the presence of old tears, 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?

Replies

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 unworthy 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 - this 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 pelvis mothers;
the fetus is large, which is why perineal ruptures occur during childbirth;
fast, rapid labor, especially if the baby is born incorrect 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 there is still something a woman can do to reduce her risk. pathological childbirth. This is to pay attention to vaginal discharge - after all, they are the main symptom inflammatory process, which can become one of the provocateurs of breakups. 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 has had complicated cervical ruptures, that is, extending to the vaginal walls, which have a large area, she should undergo a thorough examination by a gynecologist before a new pregnancy. 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.

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Violation of the integrity of the cervix during childbirth, with the formation of a wound with torn or linear edges, is called cervical rupture and is included in the list of obstetric injuries. According to various authors, cervical ruptures occur in 6-15% of cases.

Causes

The causes of cervical rupture are very numerous:

inflammatory diseases of the cervix;
history of surgical treatment of cervical pathology (diathermocoagulation, cervical surgery);
cicatricial deformation of the cervix after intrauterine manipulation (abortion, curettage, previous births with cervical ruptures);
hyperextension of the cervix during childbirth with a large fetus or during extension insertion of the head;
rapid and rapid childbirth;
protracted labor (prolonged standing of the presenting part in one plane of the small pelvis, as a result of which the cervix is compressed and the blood supply in it is disrupted);
instrumental childbirth (overlay obstetric forceps, vacuum extraction of the fetus, manual release and discharge of placenta, obstetric aids for breech presentations);
fruit-destroying operations;
improper management of the pushing period, early pushing activity;
cervical dystocia (insufficient dilatation), cervical rigidity;

Signs of uterine rupture

Cervical ruptures are classified by degree:

1st degree - a gap no more than 2 cm long;
2nd degree - the gap exceeds 2 cm in length, but does not reach the vaginal vault;
3rd degree - the rupture has passed to the vaginal vault and/or the lower segment of the uterus (lost in depth).

Clinical manifestations are usually absent in cases of 1st degree cervical ruptures. A characteristic feature Damage to the cervix results in bleeding, but it does not always appear. The intensity of bleeding depends not on the degree of rupture, but on the caliber of the damaged vessel.

A cervical rupture can be suspected immediately after the expulsion of the fetus and the passage of the placenta and bleeding that appears against the background of a well-contracted uterus. The blood is scarlet in color, may flow out in a trickle, or intense bleeding may develop.

The suspected diagnosis can be confirmed by examining the cervix in a speculum immediately after labor is completed. In this case, the cervix is grabbed by fenestrated clamps and “crossed.”

Treatment

All cervical ruptures are subject to surgical treatment, that is, suturing. The operation is performed without anesthesia. The edges of the cervical tears are captured with clamps and brought down into the vagina. The first suture is applied, retreating 0.5 cm from the upper edge of the tear. Subsequent sutures are applied at intervals of 1 cm, matching the edges of the wound, approaching the external cervical os.

For suturing cervical ruptures, catgut is used, which resolves itself after 5-7 days. After the manipulation, the cervix is treated alcohol solution Yoda.

If a third-degree rupture is detected, manual monitoring of the uterine cavity is indicated to exclude the transition of the rupture from the cervix to the body of the uterus. If a rupture of the lower segment of the uterus is diagnosed, a laparotomy is performed, during which the degree of damage to the uterus is determined and the issue of its removal (amputation or extirpation) or preservation (suturing of a uterine rupture) is decided.

Complications and consequences

In some cases, cervical ruptures go unnoticed (either there was no bleeding and an inattentive examination of the cervix was carried out after childbirth, or the birth occurred outside the walls medical institution), which is fraught with the development of the following complications:

late bleeding postpartum period and development hemorrhagic shock;
the formation of a postpartum ulcer, which gives impetus to the development of cervical diseases in the future and its cicatricial deformation;
cervical eversion (ectropion), is a prerequisite for the development of cervical cancer;
ascending infection (the occurrence of endometritis, adnexitis, which can lead to infertility);
cervical incompetence or isthmic-cervical insufficiency (ICI).

ICI may in the future cause miscarriage, late abortion or premature birth.

Scars on the cervix in subsequent births also contribute to the development of labor anomalies (weakness of labor, incoordination), cervical dystocia during labor (insufficient dilatation), which often leads to cesarean section.

The impact of trauma on the outcome of childbirth and on the fetus

Since cervical ruptures often occur in the second stage of labor, their course, as a rule, does not deviate from the physiological one and childbirth ends safely with the birth of a live fetus.

But in succession period and after labor is completed, there is a threat of massive bleeding and the development of hemorrhagic shock, which requires immediate assistance (suturing the rupture).