Obstetrics and gynecology. Birth trauma (most important)

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Obstetrics and gynecology. Birth trauma (most important)

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27. Birth injury

During childbirth, ruptures of the cervix, vagina, perineum, and vulva can occur. This happens with violent and rapid childbirth, with large fetal sizes, etc. Therefore, in the early postpartum period, it is imperative to examine the soft tissues of the birth canal and suture the gaps. With a rupture of the soft tissues of the birth canal, bleeding is usually not heavy. If the birth was carried out at home, the puerperal must be taken to the obstetric hospital, where the soft tissues of the birth canal will be examined and the tears will be sutured. The causes of ruptures are most often childbirth with a large fetus, the imposition of forceps, inept protection of the perineum, and rapid childbirth.

There are three degrees of perineal lacerations. With a rupture of the XNUMXst degree, the integrity of the posterior commissure, the vaginal wall in the region of its lower third, and the skin of the perineum are violated. With a rupture of the II degree, the skin of the perineum, the walls of the vagina and the muscles of the perineum are disturbed (except for the external sphincter of the rectum). With a rupture of the III degree, the external sphincter of the rectum is additionally damaged.

There are also three degrees of rupture of the cervix. I degree - a gap on one or both sides of not more than 2 cm, II degree - a gap of more than 2 cm, but not reaching the fornix of the vagina, III degree - a gap reaching the fornix or passing to it.

uterine rupture called violation of its integrity.

A complication of pregnancy is observed in 2-3 cases per 10 births. Distinguish between complete and incomplete rupture of the uterus. A complete rupture is characterized by a violation of the integrity of all layers of the uterus. Where parts of the peritoneum do not adhere tightly to the myometrium, incomplete ruptures of the uterus occur. An incomplete rupture is usually noted in the lower segment, lateral sections. In these cases, the integrity of the mucous membrane and the muscular layer of the uterus is violated, and the blood flowing under the visceral peritoneum forms an extensive subperitoneal hematoma.

There are spontaneous and violent uterine ruptures. Violent ruptures of the uterus are observed with the wrong actions of the obstetrician during the performance of obstetric benefits and operations. Spontaneous uterine ruptures are more common, resulting from inflammatory and degenerative changes in the myometrium formed after abortion, childbirth, caesarean section, removal of myomatous nodes, removal of the fallopian tube, suturing of a perforation, etc. These histopathic uterine ruptures occur in the second half of pregnancy, especially after the 30th week, or during childbirth. A mechanical obstruction to the advancement of the fetus (mismatch between the size of the presenting part of the fetus and the mother's pelvis) is the most common cause of spontaneous uterine rupture, observed mainly at the end of the dilatation period.

Before uterine rupture, symptoms of impending rupture are usually noted. With histopathic and mechanical genesis of uterine rupture, the symptoms of a threatening rupture are different.

Author: Ivanov A.I.

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