The author - Sozinova AV practicing obstetrician-gynecologist. Experience in the specialty since 2001.
Violation of the integrity of the cervix during labor, to produce a wound with ragged edges or linear, called a cervical fracture and the part of the list of obstetric injuries. According to various authors cervical fractures occur in 6-15% of cases.
Causes
Cause of cervical fractures are numerous:
- inflammatory diseases of the cervix;
- Surgical treatment of cervical pathology in history (diathermocoagulation operations on the cervix);
- scar deformation of cervix after intrauterine manipulation (abortion, curettage, previous generations with the neck fractures);
- cervical hyperextension intrapartum large fruit or extensor insertion head;
- rapid and fast delivery;
- prolonged labor (prolonged standing presenting part in one pelvic plane, whereby the pin is compressed and the blood flow is disturbed in it);
- instrumental delivery (forceps, vacuum extraction of the fetus, manual removal of placenta and isolation, obstetric benefits breech);
- plodorazrushayuschie operation;
- improper maintenance bearing-down period, early bearing-down activity;
- cervical dystocia (insufficient disclosure), stiff neck;
- discoordination tribal forces.
Symptoms of uterine rupture
cervical ruptures are classified by degree:
- 1 degree - the gap is no longer than 2 cm;
- 2nd stage - the gap is greater than 2 cm in length, but does not reach the vaginal fornix;
- 3 degree - gap switched to the vaginal vault and / or lower uterine segment (lost in depth).
Clinical manifestations are usually absent in cervical rupture of 1 degree. A characteristic feature of cervical lesions is bleeding, but it does not always appear. bleeding intensity does not depend on the extent of the gap, and the caliber of the damaged vessel.
Suspected neck gap can be immediately after the expulsion of the fetus and placenta and there was a discharge of bleeding against the backdrop of a well-contracted uterus. Blood at the same scarlet color, can flow or trickle developing intensive bleeding.
Confirm the presumptive diagnosis of cervical allows inspection in the mirror immediately after the birth. In this case, the cervix is gripped fenestrated forceps and "moved".
Treatment
All cervical fractures are subject to surgical treatment, ie suturing. The operation is performed without anesthesia. The edges of the neck of the gripping jaws and breaks are reduced in the vagina. The first seam is applied, in retreat 0.5cm from the upper edge of the gap. Subsequent welds overlap at an interval of 1 cm, comparing the wound edges closer to the outer zevu cervix.
For closing the gaps cervical suture is used, which is 5-7 days resolves itself. After manipulation of the cervix are treated with an alcohol solution of iodine.
Upon detection of rupture of the third degree is shown holding the manual control of the uterus in order to avoid a break with the transition of the neck to the body of the uterus. In the case of diagnostic gap of the lower uterine segment, laparotomy is performed, during which establishes the degree uterine damage and solve the problem of its removal (amputation or extirpation) or save (suturing gap uterus).
Complications and consequences
In some cases, cervical fractures remain unnoticed (or absent bleeding, and was conducted inattentive examination of the cervix after childbirth or birth occurred outside the hospital), which is fraught with the development of the following complications:
- Bleeding in the late postpartum period and the development of hemorrhagic shock;
- postnatal formation of ulcers, which gives an impetus to the development of cervical disease and its future scar deformation;
- eversion of the cervix (ectropion) is a prerequisite for the development of cervical cancer;
- ascending infection (occurrence endometritis, adnexitis, which is fraught with infertility);
- insolvency or neck cervical incompetence (CIN).
CIN in the future may cause miscarriage, late abortion or premature birth.
Scars on the neck in the following childbirth also contribute to the development of anomalies of labor activity (weakness of tribal forces, Discoordination), cervical dystocia in childbirth (insufficient disclosure), which often leads to cesarean section.
The impact of trauma on birth outcomes and fetal
Since cervical fractures often occur in the second stage of labor, they are for, as a rule, does not deviate from the physiological and childbirth safely completed with the birth of a live fetus.
But successive period and after birth there is a risk of major bleeding and the development of hemorrhagic shock, which requires immediate assistance (closure of the gap).