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Common Birth Injuries to Mothers

Childbirth is widely considered one of life's most amazing, yet frightening, experiences. The excitement and joy that comes with the prospect of bringing a new child into the world often comes with the anticipation of pain. While the pain of labor and delivery is something that's widely discussed, there are other factors, such as maternal birth injuries, that new mothers are often unaware of. A birth injury, depending on the type, can range from minor discomfort to long-lasting pain or changes to certain bodily functions. For some, the consequences of these injuries may have a mild impact that affects them for only a few days, or they may be long-lasting, with pain or discomfort that stays with them for years. In some extreme cases, the impact of a birth injury may even cause a new mother or family to consider consulting a lawyer. For this reason, it's important that expecting mothers understand what can happen to their bodies when they deliver a baby either naturally or by cesarean section.

Vaginal Tears

During childbirth, a baby's head may encounter difficulties that can cause a tear in the vaginal area. This may happen when the vagina does not easily stretch to accommodate the baby's head. Tears may also be caused by births that happen too quickly, the baby's positioning, forceps-assisted deliveries, or being overweight. There are four degrees of tears, ranging from mild to severe. Some tears, only involve the perineal skin, which is the skin between the vaginal opening and the rectum. The tissue just beneath the perineal skin may also be torn, but stitches are not always required. Other lacerations involve tearing of the muscle as well and may extend down to the anus, the anal sphincter, or even the rectum. The greater the tear, the more likely it is that surgical repair will be required. These types of lacerations are not uncommon: Roughly 95 percent of women experience some degree of tearing when they deliver their first child. Additional problems that can stem from this type of injury include urinary and fecal incontinence and painful sexual intercourse.

Broken Bones

Some women may experience bone injuries as a result of childbirth. A fractured coccyx or separated pubic symphysis are both examples of this type of problem. With a separated pubic symphysis, the baby's head may cause the pubic symphysis, which is the section of cartilage where the left and right bones of the pelvic girdle connect, to separate, causing a gap. This can cause pain and discomfort that may last as little as two months but can take as long as eight months to heal. With a fractured coccyx, the mother's tailbone may fracture or bruise as a result of pressure from the baby's head during delivery.

Uterine Rupture

A uterine rupture is a rare condition that can happen before or during labor and delivery. This may occur when a baby is abnormally large and the strain causes a uterine scar from a previous C-section to rupture during a vaginal delivery, or it may happen as a result of trauma. When the uterus tears, the baby, the placenta, or both may go into the abdominal cavity of the mother. This can cause a number of additional complications, ranging from urologic injury to hemorrhaging to even death.

Uterine Inversion

Uterine inversion is a serious problem in which the placenta remains attached to the uterus, and upon its exit from the body, it tugs the uterus out with it, pulling it inside-out. This can lead to fatal hemorrhaging or shock. There are several grades of inversion, ranging from incomplete to total inversion. To treat this type of complication, the doctor has several options, which include manually reinserting the uterus, abdominal surgery, or an emergency hysterectomy, which may be necessary if the mother is at high risk of death.

Nerve Injury

Nerve damage is another complication that mothers often don't think of before childbirth. Mothers can suffer from a range of problems depending on the nerves that are damaged. Injury to the femoral nerves can cause one to suffer from weakness or numbness in the legs that makes it difficult to feel or move them. Incontinence is another problem that stems from nerve damage, happening when pelvic and pudendal nerves are injured during delivery. Damage to one's nerves may be caused when they are compressed during delivery or when tissue is stretched.

Pelvic Organ Prolapse

Pregnancy and vaginal delivery may both contribute to prolapsed pelvic organs such as a prolapsed uterus. A prolapsed uterus occurs when the uterus slips down into the vagina because pregnancy, delivery, or both have weakened the pelvic floor muscles. Pelvic prolapse can occur with other pelvic organs as well, such as the bladder. The severity is defined in stages that range from 0 to 4. With a stage 4 prolapse, the organ will have slipped outside of the body entirely.

• The Risks of Birth by Cesarean Section
• Problems After Childbirth
• Millions of Women Are Injured During Childbirth
• Childbirth and Incontinence: Things You Should Know
• Pregnancy, Childbirth, and Bladder Control
• Prolapsed Uterus After Childbirth: What You Need to Know
• Pelvic Organ Prolapse Fact Sheet (PDF)
• Uterine Inversion
• Pregnancy Complications: Uterine Inversion
• Uterine Inversion (video)
• Uterine Rupture: What Family Physicians Need to Know
• Birth Complications: Uterine Rupture
• Medical Definition of Uterine Rupture
• Uterine Rupture
• Study Confirms Risk During Delivery After C-Section
• Risks of a Cesarean Procedure
• Postpartum Hemorrhage (PPH)
• Vaginal Tears in Childbirth
• Vaginal Tearing During Childbirth: What You Need to Know
• The Truth About Your Vagina Tearing During Childbirth
• After Childbirth: Pelvic Bone Problems
• Pelvic Bone Problems After Childbirth
• The Scary Truth About Childbirth
• Yes, You Can Break Your Tailbone During Labor

Birth trauma - causes, symptoms, diagnosis and treatment

Birth trauma - a collective concept that includes various damage to tissues and organs of a woman in labor or a newborn, caused by the action of birth forces. Among the birth injuries of the mother, there are hematomas, ruptures of the vulva, perineum and vagina, damage to the uterus, the formation of urogenital and enterogenital fistulas, and deformities of the pelvic bones. Many birth injuries can be life threatening. Diagnosis of birth injuries is based on external examination, gynecological examination, instrumental methods. Treatment of maternal birth injuries, as a rule, requires emergency surgical assistance and the involvement of narrow specialists (urologists, proctologists, traumatologists).

General information

Childbirth is a difficult test for the newborn fetus and mother. Therefore, after the birth of a child, experts often state the presence of various birth injuries and postpartum disorders in a woman in labor and a newborn. In obstetrics and gynecology, maternal and child birth injuries are distinguished. Birth injuries of a newborn include damage to the peripheral and central nervous systems of various nature and severity, injuries to bones and soft tissues, and internal organs. As part of this review, the main birth injuries that occur in women will be considered.

Significant stretching of the mother's birth canal during childbirth often leads to their damage. These injuries - birth injuries, can be superficial, non-rough in nature (for example, abrasions, cracks) and heal on their own in the early postpartum period, and remain unrecognized. In some cases, birth injuries are so significant that they can lead to serious postpartum complications, disability and even death of a woman. Among birth injuries of the mother there are hematomas; ruptures of the vulva, perineum, vagina, body and cervix; inversion of the uterus; sprains and ruptures of the joints of the pelvis; urogenital and enterogenital fistulas.

Birth injury

Common causes of maternal birth injury

A variety of maternal birth injuries can be caused by various mechanical and histopathic causes. The mechanical factors in the occurrence of birth injuries include violent or discoordinated labor activity, the provision of operational aids during childbirth (the application of forceps, vacuum extraction of the fetus, manual separation of the placenta, fruit-destroying operations), excessive labor stimulation, irrational management of the straining period, inadequate protection of the perineum, etc. e. Post-term pregnancy, transverse position of the fetus, breech presentation of the fetus, premature birth, narrow pelvis, polyhydramnios, multiple pregnancy, placenta previa can contribute to birth injuries.

Histopathic causes of birth injuries are due to burdened obstetric and gynecological history of the woman in labor. So, the causes of birth injuries of the uterus can be surgical interventions in the past (caesarean section, metroplasty, conservative myomectomy, complete or partial perforation of the uterus during abortion, etc.), which lead to the formation of a scar on the uterus and, as a result, inadequate contractility of the myometrium in childbirth.

The likelihood of birth canal injuries increases in the presence of anatomical defects of the genitals (intrauterine septum, uterine hypoplasia, bicornuate uterus), cervical rigidity in late primiparas, uterine hyperanteflexia. Also, birth injuries can be caused by cervicitis, adenomyosis, endometritis, colpitis, cystic drift and chorionepithelioma. In the etiopathogenesis of birth trauma, there are often several aggravating factors.

Birth injuries of the vulva and vagina

Hematomas of the vulva and vagina

Hematomas of the vulva and vagina are caused by stretching and rupture of blood vessels in the thickness of the soft tissues with intact integuments. In this case, the blood pouring out of the damaged vessel accumulates in the fiber and under the mucosa, forming a hematoma.

In case of birth injuries of soft tissues in the vulva and vagina, a blue-purple tumor appears, the size of which can reach the head of a newborn. Hematomas cause a feeling of discomfort (bursting, pressure), soreness. Large progressive hematomas extend to the pelvic tissue and may be accompanied by the development of hemorrhagic shock. Small hemorrhages usually resolve on their own; with large hematomas, their suppuration is possible. Recognition of birth injuries of soft tissues occurs during external examination and gynecological examination.

Surgical tactics are indicated for large (more than 4-5 cm in diameter) and progressive hematomas. At the same time, the tissues above the hematoma are opened, the accumulated blood is removed, the bleeding vessel is isolated and tied up, the wound is sewn up tightly. With an infected hematoma, the wound is not sutured. With a progressive hematoma, abdominotomy is sometimes required.

Tears of the vulva and vagina

Birth injuries of the vulva and vagina are most common in primiparas. Mild cracks and tears are usually asymptomatic and do not require intervention. Tears in the clitoris, urethra, vagina are accompanied by the formation of hematomas, massive bleeding, hemorrhagic shock.

Birth injuries of the vagina can be spontaneous and violent. In the latter case, the causes of birth injuries are various obstetric operations. Vaginal tears can occur in its upper, middle, or lower sections; be superficial or deep, reaching the tissue of the small pelvis and abdominal cavity.

Birth injuries of the tissues of the vulva are detected during examination. To exclude internal tears, it is necessary to examine the walls of the vagina with the help of mirrors.

The treatment of birth injuries of the vulva and vagina is exclusively surgical. After catheterization of the bladder with a metal catheter, the tears are sutured with catgut sutures. In the postoperative period, antimicrobial therapy and vaginal baths with antiseptics are prescribed. Unrecognized vaginal tears may heal uncomplicated or become infected. Deep tears can subsequently lead to secondary vaginal atresia, necessitating vaginoplasty.

Birth injuries of the perineum

Birth injuries of the perineum include violent or spontaneous ruptures of the skin, tissue and muscle-fascial tissues of the pelvic floor. Birth injuries of the perineum occur in 7-15% of women in labor, and much more often in primiparas. Perineal ruptures are often combined with birth injuries of the vagina.

Protrusion and cyanosis of the tissues of the pelvic floor, swelling and luster of tissues, cracks testify to the threat of birth injury of the perineum. If there is a threat of birth injury of the perineum, they resort to a median dissection of tissues - perineotomy or a lateral incision - episiotomy, followed by suturing.

Symptoms of perineal rupture

Depending on the depth of the birth injury, there are 3 degrees of perineal rupture.

In case of rupture of the perineum of the 1st degree, the integrity of the skin and subcutaneous tissue in the region of the posterior commissure is violated. II degree of perineal rupture is characterized by additional injuries of the pelvic floor muscles (including the muscles that lift the anus), the back or side walls of the vagina. With a birth injury of the perineum of the III degree, the rupture of the external sphincter, and sometimes the walls of the rectum, joins the above injuries.

Birth injuries of the perineum are manifested by violation of tissue integrity and bleeding.

Diagnosis and treatment of perineal tears

Birth injuries of the perineum are recognized after the birth of the placenta. To do this, the obstetrician-gynecologist spreads the genital gap, examines the walls of the vagina and the cervix. More often damage to the perineum during childbirth occurs not along the midline, but extramedially, but there is also a central gap between the posterior commissure and the muscle that lifts the anus.

Perineal tissue integrity is restored by suturing under local infiltration or general anesthesia. Separate catgut sutures are placed on the damaged walls of the vagina and rectum, pelvic floor muscles, subcutaneous tissue and perineal skin. In the postpartum period, sutures are processed, a thorough toilet of the wound after each defecation and urination, and constipation is prevented.

Birth injury of the uterus

Rupture of the uterus

Rupture of the uterus is one of the most severe birth injuries and occurs in 0.015%-0.1% of the total number of births. When the uterus ruptures, the integrity of the walls of its body is violated. The lethality of women with birth trauma of the uterus from shock, anemia and septic complications reaches 3-4%. Many women who have had uterine rupture develop hypoxic encephalopathy later on. Fetal death in uterine rupture is close to 100%.

Classification of uterine ruptures

There are uterine ruptures that occurred during pregnancy and during childbirth. According to the pathogenetic signs of birth trauma, spontaneous (mechanical, histopathic and mechanical-histopathic) and violent (traumatic, mixed) uterine ruptures are distinguished. According to the birth trauma clinic, uterine ruptures can be threatening, begun, completed.

According to the degree of damage to the walls of the uterus, birth trauma can take the form of a crack, incomplete rupture and complete rupture penetrating into the abdominal cavity. By localization, there is a rupture of the bottom of the uterus, its body, the lower segment, as well as a complete separation of the uterus from the vaginal vaults (colpoporexis) in the transverse position of the fetus.

Symptoms of uterine rupture

The clinic of birth trauma of the uterus depends on the causes, stage, degree, localization of the rupture. The severity of manifestations and consequences are largely due to the accompanying background - in the presence of somatic diseases of the woman in labor, gestosis, physical and mental exhaustion, infection, etc., irreversible changes quickly develop in the body.

Threatening uterine rupture is characterized by excessive labor activity with painful strong contractions, hourglass uterine deformity, development of edema of the cervix, vagina and vulva, difficulty urinating, anxiety of the woman in labor. With the onset of uterine rupture, the listed symptoms are supplemented by convulsive contractions, the appearance of sanious or bloody discharge from the vagina, and hematuria.

When the uterus ruptures, after a sharp pain and burning sensation in the abdomen, labor activity stops, the woman in labor calms down, becomes depressed, apathetic. Due to the development of hemorrhagic and painful shock, pallor of the skin, hypotension, tachycardia rapidly increase, cold sweat, nausea and vomiting appear. After rupture of the uterus, parts of the fetus are partially or completely palpated in the abdominal cavity, there is no fetal heartbeat. External bleeding with this birth injury can be significant or scanty, depending on the size and location of uterine rupture.

Urgent care for uterine ruptures

If there is a threat of uterine rupture, immediate termination of labor and completion of labor by operative means - caesarean section or fruit-destroying operation. With the onset or completed uterine rupture, cerebrosection is performed, the fetus and placenta are removed, amniotic fluid and blood are removed, and hemostasis is performed. The volume of intervention for these birth injuries ranges from supravaginal amputation to hysterectomy. Uterine suturing is possible in young patients with recent and small ruptures of a linear nature, the absence of infection.

At the same time, it is necessary to carry out adequate replenishment of blood loss, anti-shock infusion-transfusion therapy, and correction of hemocoagulation. If birth injuries of the uterus were not recognized, bleeding or peritonitis may develop, as well as the death of the puerperal. With infectious complications, laparotomy, removal of the uterus with appendages (panhysterectomy), drainage of the abdominal cavity, and massive antibiotic therapy are undertaken.

Cervical tears

This type of birth injury occurs according to various authors in 3-60% of women in labor. Cervical ruptures (violent or spontaneous) are divided into 3 degrees according to the depth of damage: I - a defect of no more than 2 cm; II - defect more than 2 cm, but not reaching the vaginal vaults; III - a defect that reaches the vaults and passes to them. Cervical ruptures are usually localized in the lateral sections, more often on the left.

Symptoms of cervical rupture

Birth injuries of the cervix are manifested by postpartum bleeding from the vagina after the birth of the placenta and contraction of the uterus. Blood flowing from the genital tract has a scarlet color, is released in a continuous stream or in the form of a large number of clots in the absence of external damage to the birth canal. Sometimes there is little or no bleeding. If the branches of the uterine arteries are damaged, there is a massive outpouring of blood or the formation of hematomas in the paracervical tissue, a clinic of hemorrhagic shock.

If cervical ruptures remain unrecognized, in the future it can lead to the development of postpartum ulcers, parametritis, pelvioperitonitis, spontaneous abortions, cervical dysplasia.

Diagnosis and treatment of cervical tears

To recognize birth injuries of the cervix, all postpartum women need to be examined with the help of mirrors immediately after the completion of labor, and also 6-48 hours after swelling and stretching of the tissues have decreased.

Detected ruptures of the cervix are subject to suturing immediately or delayed, no later than 2 days after birth. The sutures are applied to the ruptures of the neck through all layers of tissues, starting from the upper corner of the defect in the direction of the external pharynx. Due to unfavorable conditions (the presence of lochia, edema, crushing of tissues), birth injuries of the cervix often heal by secondary intention.

Other birth injuries

Uterine inversion

The development of acute uterine inversion is due to improper management of the afterbirth period, weakness of the uterine ligaments, and atony of the uterus. Distinguish between partial and complete eversion of the uterus. This birth injury proceeds with the phenomena of pain shock.

Treatment of uterine inversion consists in anti-shock measures and reduction of the uterus to its anatomical place under general anesthesia.

Sprains and ruptures of the pelvic joints

These birth injuries develop with excessive softening of the joints of the pelvis (symphysiopathy, symphysitis), childbirth with a premature or large fetus, obstetric benefits. In this case, the pubic bones are stretched and separated at a distance of more than 0.5 cm from each other. Rupture of the pubic joint is often accompanied by displacement of bones, damage to the bladder, urethra, and clitoris. Stretching of the sacroiliac joints leads to hemorrhages and subsequent inflammation of the joints.

The clinic of birth injuries of the pelvic joints is manifested by pain in the womb, coccyx, sacrum, aggravated by abduction of the legs, walking; gait disturbance, skin hyperemia and swelling of surrounding tissues.

Birth injuries of the pelvic region are detected during a consultation with a traumatologist during examination, palpation, radiography of the pubic, sacroiliac joint, and pelvis. Treatment of sprains of the pelvic joints requires rest, tight bandaging, wearing special corsets. A rupture of the pubic symphysis or a significant divergence of the pelvic bones requires surgical intervention.

Urogenital and rectal-vaginal fistulas

Birth injuries with the formation of fistulas are caused by prolonged (more than 2 hours) standing of the baby's head in one plane, resulting in impaired blood circulation in tissues with their subsequent necrosis. Sometimes urogenital and rectal-vaginal fistulas are formed as a result of intraoperative damage to the walls of the bladder or rectum.

Fistulas are manifested by the release of urine or gases and feces through the vagina outside the acts of urination and defecation. Such disorders are always accompanied by the development of a local inflammatory reaction in the vagina (colpitis).

Diagnosis of urogenital fistulas is made during a gynecological examination, cystoscopy; rectal-vaginal fistulas are recognized by digital rectal examination, irrigoscopy, fistulography, and rectoscopy. When detecting urogenital and rectovaginal fistulas, their surgical closure (fistuloplasty) is usually required.

Prevention of birth injuries

Prevention of birth injuries of the uterus requires the study of a gynecological history of a pregnant woman in the early stages, ultrasound monitoring of the state of scars on the uterus during pregnancy, hospitalization of pregnant women with a threat of injuries in childbirth.

Prevention of birth injuries requires the rejection of forced delivery, the use of obstetric benefits strictly according to indications.

Birth trauma - causes, symptoms, diagnosis and treatment

Birth trauma is a collective concept that includes various damage to tissues and organs of a woman in labor or a newborn, caused by the action of birth forces. Among the birth injuries of the mother, there are hematomas, ruptures of the vulva, perineum and vagina, damage to the uterus, the formation of urogenital and enterogenital fistulas, and deformities of the pelvic bones. Many birth injuries can be life threatening. Diagnosis of birth injuries is based on external examination, gynecological examination, instrumental methods. Treatment of maternal birth injuries, as a rule, requires emergency surgical assistance and the involvement of narrow specialists (urologists, proctologists, traumatologists).

General information

Childbirth is a difficult test for the newborn fetus and mother. Therefore, after the birth of a child, experts often state the presence of various birth injuries and postpartum disorders in a woman in labor and a newborn. In obstetrics and gynecology, maternal and child birth injuries are distinguished. Birth injuries of a newborn include damage to the peripheral and central nervous systems of various nature and severity, injuries to bones and soft tissues, and internal organs. As part of this review, the main birth injuries that occur in women will be considered.

Significant stretching of the mother's birth canal during childbirth often leads to their damage. These injuries - birth injuries, can be superficial, non-rough in nature (for example, abrasions, cracks) and heal on their own in the early postpartum period, and remain unrecognized. In some cases, birth injuries are so significant that they can lead to serious postpartum complications, disability and even death of a woman. Among birth injuries of the mother there are hematomas; ruptures of the vulva, perineum, vagina, body and cervix; inversion of the uterus; sprains and ruptures of the joints of the pelvis; urogenital and enterogenital fistulas.

Birth injury

Common causes of maternal birth injury

A variety of maternal birth injuries can be caused by various mechanical and histopathic causes. The mechanical factors in the occurrence of birth injuries include violent or discoordinated labor activity, the provision of operational aids during childbirth (the application of forceps, vacuum extraction of the fetus, manual separation of the placenta, fruit-destroying operations), excessive labor stimulation, irrational management of the straining period, inadequate protection of the perineum, etc. e. Post-term pregnancy, transverse position of the fetus, breech presentation of the fetus, premature birth, narrow pelvis, polyhydramnios, multiple pregnancy, placenta previa can contribute to birth injuries.

Histopathic causes of birth injuries are due to burdened obstetric and gynecological history of the woman in labor. So, the causes of birth injuries of the uterus can be surgical interventions in the past (caesarean section, metroplasty, conservative myomectomy, complete or partial perforation of the uterus during abortion, etc. ), which lead to the formation of a scar on the uterus and, as a result, inadequate contractility of the myometrium in childbirth.

The likelihood of birth canal injuries increases in the presence of anatomical defects of the genitals (intrauterine septum, uterine hypoplasia, bicornuate uterus), cervical rigidity in late primiparas, uterine hyperanteflexia. Also, birth injuries can be caused by cervicitis, adenomyosis, endometritis, colpitis, cystic drift and chorionepithelioma. In the etiopathogenesis of birth trauma, there are often several aggravating factors.

Birth injuries of the vulva and vagina

Hematomas of the vulva and vagina

Hematomas of the vulva and vagina are caused by stretching and rupture of blood vessels in the thickness of the soft tissues with intact integuments. In this case, the blood pouring out of the damaged vessel accumulates in the fiber and under the mucosa, forming a hematoma.

In case of birth injuries of soft tissues in the vulva and vagina, a blue-purple tumor appears, the size of which can reach the head of a newborn. Hematomas cause a feeling of discomfort (bursting, pressure), soreness. Large progressive hematomas extend to the pelvic tissue and may be accompanied by the development of hemorrhagic shock. Small hemorrhages usually resolve on their own; with large hematomas, their suppuration is possible. Recognition of birth injuries of soft tissues occurs during external examination and gynecological examination.

Surgical tactics are indicated for large (more than 4-5 cm in diameter) and progressive hematomas. At the same time, the tissues above the hematoma are opened, the accumulated blood is removed, the bleeding vessel is isolated and tied up, the wound is sewn up tightly. With an infected hematoma, the wound is not sutured. With a progressive hematoma, abdominotomy is sometimes required.

Tears of the vulva and vagina

Birth injuries of the vulva and vagina are most common in primiparas. Mild cracks and tears are usually asymptomatic and do not require intervention. Tears in the clitoris, urethra, vagina are accompanied by the formation of hematomas, massive bleeding, hemorrhagic shock.

Birth injuries of the vagina can be spontaneous and violent. In the latter case, the causes of birth injuries are various obstetric operations. Vaginal tears can occur in its upper, middle, or lower sections; be superficial or deep, reaching the tissue of the small pelvis and abdominal cavity.

Birth injuries of the tissues of the vulva are detected during examination. To exclude internal tears, it is necessary to examine the walls of the vagina with the help of mirrors.

The treatment of birth injuries of the vulva and vagina is exclusively surgical. After catheterization of the bladder with a metal catheter, the tears are sutured with catgut sutures. In the postoperative period, antimicrobial therapy and vaginal baths with antiseptics are prescribed. Unrecognized vaginal tears may heal uncomplicated or become infected. Deep tears can subsequently lead to secondary vaginal atresia, necessitating vaginoplasty.

Birth injuries of the perineum

Birth injuries of the perineum include violent or spontaneous ruptures of the skin, tissue and muscle-fascial tissues of the pelvic floor. Birth injuries of the perineum occur in 7-15% of women in labor, and much more often in primiparas. Perineal ruptures are often combined with birth injuries of the vagina.

Protrusion and cyanosis of the tissues of the pelvic floor, swelling and luster of tissues, cracks testify to the threat of birth injury of the perineum. If there is a threat of birth injury of the perineum, they resort to a median dissection of tissues - perineotomy or a lateral incision - episiotomy, followed by suturing.

Symptoms of perineal rupture

Depending on the depth of the birth injury, there are 3 degrees of perineal rupture.

In case of rupture of the perineum of the 1st degree, the integrity of the skin and subcutaneous tissue in the region of the posterior commissure is violated. II degree of perineal rupture is characterized by additional injuries of the pelvic floor muscles (including the muscles that lift the anus), the back or side walls of the vagina. With a birth injury of the perineum of the III degree, the rupture of the external sphincter, and sometimes the walls of the rectum, joins the above injuries.

Birth injuries of the perineum are manifested by violation of tissue integrity and bleeding.

Diagnosis and treatment of perineal tears

Birth injuries of the perineum are recognized after the birth of the placenta. To do this, the obstetrician-gynecologist spreads the genital gap, examines the walls of the vagina and the cervix. More often damage to the perineum during childbirth occurs not along the midline, but extramedially, but there is also a central gap between the posterior commissure and the muscle that lifts the anus.

Perineal tissue integrity is restored by suturing under local infiltration or general anesthesia. Separate catgut sutures are placed on the damaged walls of the vagina and rectum, pelvic floor muscles, subcutaneous tissue and perineal skin. In the postpartum period, sutures are processed, a thorough toilet of the wound after each defecation and urination, and constipation is prevented.

Birth injury of the uterus

Rupture of the uterus

Rupture of the uterus is one of the most severe birth injuries and occurs in 0.015%-0.1% of the total number of births. When the uterus ruptures, the integrity of the walls of its body is violated. The lethality of women with birth trauma of the uterus from shock, anemia and septic complications reaches 3-4%. Many women who have had uterine rupture develop hypoxic encephalopathy later on. Fetal death in uterine rupture is close to 100%.

Classification of uterine ruptures

There are uterine ruptures that occurred during pregnancy and during childbirth. According to the pathogenetic signs of birth trauma, spontaneous (mechanical, histopathic and mechanical-histopathic) and violent (traumatic, mixed) uterine ruptures are distinguished. According to the birth trauma clinic, uterine ruptures can be threatening, begun, completed.

According to the degree of damage to the walls of the uterus, birth trauma can take the form of a crack, incomplete rupture and complete rupture penetrating into the abdominal cavity. By localization, there is a rupture of the bottom of the uterus, its body, the lower segment, as well as a complete separation of the uterus from the vaginal vaults (colpoporexis) in the transverse position of the fetus.

Symptoms of uterine rupture

The clinic of birth trauma of the uterus depends on the causes, stage, degree, localization of the rupture. The severity of manifestations and consequences are largely due to the accompanying background - in the presence of somatic diseases of the woman in labor, gestosis, physical and mental exhaustion, infection, etc., irreversible changes quickly develop in the body.

Threatening uterine rupture is characterized by excessive labor activity with painful strong contractions, hourglass uterine deformity, development of edema of the cervix, vagina and vulva, difficulty urinating, anxiety of the woman in labor. With the onset of uterine rupture, the listed symptoms are supplemented by convulsive contractions, the appearance of sanious or bloody discharge from the vagina, and hematuria.

When the uterus ruptures, after a sharp pain and burning sensation in the abdomen, labor activity stops, the woman in labor calms down, becomes depressed, apathetic. Due to the development of hemorrhagic and painful shock, pallor of the skin, hypotension, tachycardia rapidly increase, cold sweat, nausea and vomiting appear. After rupture of the uterus, parts of the fetus are partially or completely palpated in the abdominal cavity, there is no fetal heartbeat. External bleeding with this birth injury can be significant or scanty, depending on the size and location of uterine rupture.

Urgent care for uterine ruptures

If there is a threat of uterine rupture, immediate termination of labor and completion of labor by operative means - caesarean section or fruit-destroying operation. With the onset or completed uterine rupture, cerebrosection is performed, the fetus and placenta are removed, amniotic fluid and blood are removed, and hemostasis is performed. The volume of intervention for these birth injuries ranges from supravaginal amputation to hysterectomy. Uterine suturing is possible in young patients with recent and small ruptures of a linear nature, the absence of infection.

At the same time, it is necessary to carry out adequate replenishment of blood loss, anti-shock infusion-transfusion therapy, and correction of hemocoagulation. If birth injuries of the uterus were not recognized, bleeding or peritonitis may develop, as well as the death of the puerperal. With infectious complications, laparotomy, removal of the uterus with appendages (panhysterectomy), drainage of the abdominal cavity, and massive antibiotic therapy are undertaken.

Cervical tears

This type of birth injury occurs according to various authors in 3-60% of women in labor. Cervical ruptures (violent or spontaneous) are divided into 3 degrees according to the depth of damage: I - a defect of no more than 2 cm; II - defect more than 2 cm, but not reaching the vaginal vaults; III - a defect that reaches the vaults and passes to them. Cervical ruptures are usually localized in the lateral sections, more often on the left.

Symptoms of cervical rupture

Birth injuries of the cervix are manifested by postpartum bleeding from the vagina after the birth of the placenta and contraction of the uterus. Blood flowing from the genital tract has a scarlet color, is released in a continuous stream or in the form of a large number of clots in the absence of external damage to the birth canal. Sometimes there is little or no bleeding. If the branches of the uterine arteries are damaged, there is a massive outpouring of blood or the formation of hematomas in the paracervical tissue, a clinic of hemorrhagic shock.

If cervical ruptures remain unrecognized, in the future it can lead to the development of postpartum ulcers, parametritis, pelvioperitonitis, spontaneous abortions, cervical dysplasia.

Diagnosis and treatment of cervical tears

To recognize birth injuries of the cervix, all postpartum women need to be examined with the help of mirrors immediately after the completion of labor, and also 6-48 hours after swelling and stretching of the tissues have decreased.

Detected ruptures of the cervix are subject to suturing immediately or delayed, no later than 2 days after birth. The sutures are applied to the ruptures of the neck through all layers of tissues, starting from the upper corner of the defect in the direction of the external pharynx. Due to unfavorable conditions (the presence of lochia, edema, crushing of tissues), birth injuries of the cervix often heal by secondary intention.

Other birth injuries

Uterine inversion

The development of acute uterine inversion is due to improper management of the afterbirth period, weakness of the uterine ligaments, and atony of the uterus. Distinguish between partial and complete eversion of the uterus. This birth injury proceeds with the phenomena of pain shock.

Treatment of uterine inversion consists in anti-shock measures and reduction of the uterus to its anatomical place under general anesthesia.

Sprains and ruptures of the pelvic joints

These birth injuries develop with excessive softening of the joints of the pelvis (symphysiopathy, symphysitis), childbirth with a premature or large fetus, obstetric benefits. In this case, the pubic bones are stretched and separated at a distance of more than 0.5 cm from each other. Rupture of the pubic joint is often accompanied by displacement of bones, damage to the bladder, urethra, and clitoris. Stretching of the sacroiliac joints leads to hemorrhages and subsequent inflammation of the joints.

The clinic of birth injuries of the pelvic joints is manifested by pain in the womb, coccyx, sacrum, aggravated by abduction of the legs, walking; gait disturbance, skin hyperemia and swelling of surrounding tissues.

Birth injuries of the pelvic region are detected during a consultation with a traumatologist during examination, palpation, radiography of the pubic, sacroiliac joint, and pelvis. Treatment of sprains of the pelvic joints requires rest, tight bandaging, wearing special corsets. A rupture of the pubic symphysis or a significant divergence of the pelvic bones requires surgical intervention.

Urogenital and rectal-vaginal fistulas

Birth injuries with the formation of fistulas are caused by prolonged (more than 2 hours) standing of the baby's head in one plane, resulting in impaired blood circulation in tissues with their subsequent necrosis. Sometimes urogenital and rectal-vaginal fistulas are formed as a result of intraoperative damage to the walls of the bladder or rectum.

Fistulas are manifested by the release of urine or gases and feces through the vagina outside the acts of urination and defecation. Such disorders are always accompanied by the development of a local inflammatory reaction in the vagina (colpitis).

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