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    Birth Canal Injuries Final Lecture

    Uploaded by

    Anjali Rahul Ajmeri
    This document discusses common birth injuries including perineal tears, cervical tears, and vaginal lacerations. It describes exploring the perineum and genital tract under good light to identify any tears, which are then repaired. Perineal tears are classified by degree of severity from 1st to 4th degree. Prevention, repair techniques, post-operative care, and management of associated bleeding are covered.

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    © All Rights Reserved
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    Birth Canal Injuries Final Lecture

    Uploaded by

    Anjali Rahul Ajmeri
    167 views28 pages
    This document discusses common birth injuries including perineal tears, cervical tears, and vaginal lacerations. It describes exploring the perineum and genital tract under good light to identify any tears, which are then repaired. Perineal tears are classified by degree of severity from 1st to 4th degree. Prevention, repair techniques, post-operative care, and management of associated bleeding are covered.

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    This document discusses common birth injuries including perineal tears, cervical tears, and vaginal lacerations. It describes exploring the perineum and genital tract under good light to identify any tears, which are then repaired. Perineal tears are classified by degree of severity from 1st to 4th degree. Prevention, repair techniques, post-operative care, and management of associated bleeding are covered.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    167 views28 pages

    Birth Canal Injuries Final Lecture

    Uploaded by

    Anjali Rahul Ajmeri
    This document discusses common birth injuries including perineal tears, cervical tears, and vaginal lacerations. It describes exploring the perineum and genital tract under good light to identify any tears, which are then repaired. Perineal tears are classified by degree of severity from 1st to 4th degree. Prevention, repair techniques, post-operative care, and management of associated bleeding are covered.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 28

     One should suspect traumatic bleeding in women

    having excessive bleeding after expulsion of


    placenta and uterus is well contracted.
     In such cases the perineum and lower genital
    tract should be explore under good light.
    Common birth canal injuries are –
    I. Perineal tear
    II.vaginal and cervical tear
     Periurethral lacerations
     Periclitoral lacerations
     Vaginal lacerations
     Cervical lacerations/ cervical

    tear
    • Occurs due to pressure from delivering head
    to the anterior perineum by the intact
    posterior perineum.
    • If light bleeding- pressure with a pad for 1-2
    minutes arrest the bleeding
    • If significant bleeding- repair to be done
    using fine continuous sutures.
    • If stitches are taken urethral catheter be
    placed.
     Gross perineal tear is usually due to mismanaged
    2nd stage of labour.
    Degree of perineal tear –
     1st degree perineal tear- it involves the vaginal

    mucosa and subcutaneus tissue and forchette.


     2nd degree perineal tear- it involves the vaginal

    mucosa , subcutaneous tissue (connective tissue)


    varying degree of perineal body tear but it is not
    reaching up to external anal sphincter.
     1st & 2nd perineal tears are termed as
    incomplete perineal tear.
     3rd degree perineal tear- in this injury to
    perineum involves –post vaginal wall tear of
    whole of the perineum as well as complete
    transection of anal sphincter .
     4thdegree perineal tear- involving the
    vaginal mucosa, perineum, anal sphincter,
    anal and rectal mucosa

     3rd
    & 4th degree perineal tear are complete
    perineal tear.
     Prevention- proper conduction of 2 nd stage of
    labour is preventive i.e,
     Early extension of head during delivery to be

    avoided
     Slow delivery of fetal head in between

    contraction
     To perform timely episiotomy when indicated
     To take care of perineum during delivery of

    shoulder.
     Recent perineal tear should be repaired
    immediately following delivery of placenta.
     In case of delay more than 24 hrs immediate

    repair to be with held. In 2nd degree it should


    done after antibiotic coverage and when ever
    wound become clean.
     In case of complete perineal tear when delay

    is >24 hrs then repair to be done after 3 rd


    month of delivery.
     Itis just like episiotomy repair i.e. stitch the
    vaginal mucosa, subcutaneous tissue , and
    skin-suture material 1 or 1-0
     Patient is to be put in lithotomy position
     All aseptic precaution to be taken
     Local anaesthesia or preferable GA.
     Suture material used is 1-0 vicryl or chromic

    cut gut
     The rectal mucosa is sutured 1 st from above

    downward with interrupted suture


     Then stitch the rectal muscle and para-rectal

    fascia by interrupted suture


     Now explore the torn end of anal sphincter
    with the help of allies forceps
     Torn end of sphincter are sutured in midline by

    figure of eight stitch


     It is supported by another layer of interrupted

    suture
     Stitch the vaginal mucosa, perineal muscles

    and skin by interrupted suture.


     Just like episiotomy cleaning and dressing of
    wound after each urination and defecation.
    Special care to be taken in repair of complete
    perineal tear-
     Liquid diet on 1st day
     Low residual diet (such as milk, rice, bread,

    egg, fish, potato, sweets, fruit juice)for 4 days.


     Lactose 8ml twice a day for one week to

    soften the stool


     Broad spectrum antibiotics along with
    metronidozol (400mg) TDS for 5-7 days
     Avoid giving enema and rectal
    examination for two weeks
     Minor degree of cervical tear is during 1 st
    delivery is common.
     It is commonest cause of traumatic PPH
     Left lateral cervical tear is more common
    I. Iatrogenic- in case of operative vaginal
    delivery or breech extraction through
    incomplete dilatation of cervix
    II. Rigid cervix following previous cervical
    operation
    III. Precipitate labour
     Cervical tear or vaginal tear should be
    suspected when PPH is there in-spite of
    well contracted uterus.
     Explore the cervix and vagina for tear
    under good light.
    Exploration of cervix
     With all aseptic precaution
     Evacuation of bladder if full
     Place the patient in lithotomy position
     Insert speculum and retract the posterior
    vaginal wall
     Ask the assistant to push down the fundus of uterus gently.
     Hold the anterior lip of cervix with sponge holder and trace
    whole of the cervix with another sponge holder forceps in
    clock wise manner and identify the cervical tear
     Now grasped the both margin of the tear of cervix by the
    sponge holder.
     Stitchthe cervical tear by interrupted
    mattress suture by taking the whole
    thickness of cervix, suture material is 1-0
    chromic catgut with round body needle.

     The repair should be started 1 cm above


    the apex of the tear.
     Mattress suture prevents rolling of the edges.

     If
    the cervical tear is extending to the lower
    segment or vault with broad ligament
    haematoma needs laparotomy.
     After the proper exposure haemostatic suture
    and vaginal tear suturing to be done if multiple
    laceration, then pack the vagina for 24 hrs.
    after removing the packing see for bleeding
     Vulva injuries- vulval laceration, perineal
    laceration and hematoma needs to be drained
    and proper haemostatic suture should be given

     Sometime local packing requires.


     Vulval haematoma
     Paravaginal haematoma
     Broad ligament and
    retroperitoneal haematoma
     Small vulval haematomas (≤5 cm) may be
    treated conservatively with analgesics,
    observation and ice packs
     If pain is not controlled, enlarging or large

    haematoma need to incise and evacuate.


     Regional / general anaesthesia needed.
     Incision is made over the most prominent

    area and clots evacuated.


     Discreet bleeding points are ligated although
    frequently none are found
     Oozing areas may be oversewn with figure-

    of-eight sutures
     Vaginal packing be done
     Foley catheter is placed
     Broad spectrum antibiotics be given.
     Sub peritoneal and supravaginal haematomas
    not repaired vaginally
     Laparotomy is advisable
     Angiographic embolisation of internal iliac

    arteries may be done.

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