Unfortunately, the tears during childbirth are very common, and the frequency of their primiparous older than 30 years was significantly higher.
Gaps in childbirth as possible in the perineum and vagina so the cervix may be gaps. The most severe, fatal complication of a uterine rupture during labor. If the outer gaps simply sutured after delivery, uterine rupture requires emergency cesarean section because it threatens the life of the mother and the child can not save very rarely.
Everything perineal tears during childbirth are divided into internal and external. The internal attribute the gap of the cervix and the vagina adjacent to the outer gap is tearing of the perineum and the lower third of the vagina.
Perineal tear during childbirth
Perineal tears during childbirth are the most frequent trauma mothers. They are found in primiparous, and multiparous.
The main causes of perineal tears:
– Large fruit
– High crotch
– Rigidity (no stretch) of the perineum
– Not adequate behavior mothers in childbirth, violent attempts and rapid delivery
– Delivery in breech presentation, incorrect insertion of the fetal head
– Inflammation of the genital organs
– Swelling of the perineum during childbirth protracted
Perineal rupture usually occurs at the time of the eruption of the fetal head, with the probability of rupture is easily determined visually midwife. Perineal skin turns pale and becomes shiny. In such cases, correctly and efficiently produce perineotomy or episiotomy, as always incised wound heals better and faster than a torn and the scar turns smooth.
Perineotomy is cut along the midline of the vagina to the anus, an episiotomy is an incision in the side. Episiotomy is safer, because if perineotomy continued cut in the gap at birth may lead to its spread up to the anus. However, on the other hand, after the closure of the incision perineotomy leads to better functional outcome, the anatomy of this area much easier.
Rupture of the perineum are classified depending on its length in the Grade 3:
– A degree of damage is accompanied by a mucous membrane of the vagina and the posterior commissure of the labia.
– 2 degree perineal involves muscles of the vagina and perineum.
– 3 degree gap is accompanied by damage to the anus, and even the walls of the rectum.
Rupture of the perineum is always accompanied by bleeding, which is detected immediately after birth.
After birth, gynecologist examines the perineum and vagina for signs of damage, if necessary sutured catgut suture breaks, which are then removed for 5 days before discharge from hospital.
With inadequate suturing ruptures in the future, the formation of a hematoma of the perineum, and lead to tears unsutured wound healing rough scar, resulting in a woman is suffering because of problems in sexual life and in subsequent births. Moreover, the failure may develop pelvic floor, and this leads to the omission of sexual organs (uterus and vagina), which requires a sufficiently large and complex operations in the future.
Myocardial rupture of the perineum predisposes to recurrence of the situation in subsequent births.
Sometimes you need to make an artificial incision of the perineum, even without the threat of discontinuity. This is done in the following cases:
– Premature birth. In such cases, the incision of the perineum (episiotomy) reduces the pressure on the head of the fetus, to that he is not ready yet.
– The need to expedite the second stage of labor when the mother of some medical conditions (such as heart defects), or the threat of a child (hypoxia in utero).
– Breech presentation. Breech baby’s head is relatively large compared with its pelvic end may make it difficult childbirth.
– Operative intervention in childbirth, for example, vacuum extraction of the fetus.
Vaginal tears during childbirth
Vaginal tears do not occur in isolation, they are accompanied by either rupture of the perineum, or rupture of the uterine cervix.
Breaks of the cervix during labor
Breaks of the cervix during childbirth occur in the early period of the expulsion of the fetus. They almost always occur because most new mothers.
At the beginning of the period of exile, when cervical dilatation reached 8 cm, and the head is pressed to exit from the pelvis, there is a strong desire to push, but you can not push until full disclosure, see 10 If a woman does not listen to the midwife, and starts in this the time to push the pressure on the baby’s head is not yet finished the cervix leads to the inevitable breakup. Thus there is also a high risk of injury to a child.
Exist a need to fight and those attempts, they are the most painful for the entire period of delivery, and require the greatest composure. Typically, full disclosure is 15-20 minutes and these minutes decide the fate of your cervix.
Breaks of the cervix as classified by degrees.
– A degree of rupture – rupture of the cervix on either side of not more than 2 cm in length
– 2 degree gap – a gap of the cervix than 2 cm in length without going to the vaults of the vagina.
– 3 degree gap is the gap that extends to the vaginal vaults.
Manifestation of rupture of the cervix is bleeding after childbirth. Gaps of 3 degrees are often accompanied by an accumulation of blood in the parametrium (tissue parauterine).
All the tears of the cervix should be sutured after delivery, catgut sutures are applied non-removable, they will disappear in the future for yourself.
Anesthesia for suturing tears of the cervix is not required because the cervix does not have pain receptors. If tears of the cervix is not sutured in the future may develop ectropion (eversion) cervical erosion and cervicitis.
Uterine rupture during labor
Uterine rupture during labor is very rare, but almost always end with the death of a child and can lead to maternal death.
Rupture usually occurs in the lower uterine segment.
The causes of uterine rupture during labor:
– Large fruit, misuse of his presentation, preventing the birth.
– The presence of a narrow pelvis or other obstructions leave a mechanical nature.
– Not a wealthy scar on the uterus after a prior cesarean section.
Threatened rupture of uterus sore appears at the bottom of its segment, and the pain does not pass between contractions, when viewed from a gynecologist detects specific symptoms of threatening rupture of the uterus showing hyperextension of the lower segment.
The only way to a successful outcome of labor – an emergency cesarean section. If this is not done, the woman feels “like something torn inside,” a sharp pain clinic developed internal bleeding, and the fetus develops severe hypoxia, leading to a minute to fetal death.
Gaps in childbirth care
After each delivery the doctor examines the birth canal, and no matter whether there was a cut or break – it is sutured.
All internal ruptures sutured after birth usually without anesthesia, because the cervix is not sensitive, outdoor breaks are sutured under local or general anesthesia, depending on their degree.
Superimposed on the cervix removable sutures in the vagina and vulva are also on the perineum to the skin is applied catgut sutures, or polyester, which are removed before discharge from hospital. All breaks are sutured in layers, restoring the correct anatomical relationships of tissues.
If there were gaps parturients during labor, treatment depends on the degree of discontinuity. When a woman is in hospital, before removal of sutures wounds treated brilliant green, or 5% potassium permanganate, it is done once every midwife, with serious injuries and the risk of infection prescribed antibiotics.
When expressed pain syndrome is sometimes necessary to the appointment of pain medication to reduce swelling, use ice pack.
Usually after birth allowed to stand over night, but will not sit still for about two weeks, even have to eat standing up. You will be able to be discharged from the hospital just sit down polubokom on the healthy side, and only on the firm.
Child will be fed in the supine position.
The hardest hit will break in the case of grade 3. After birth, appointed besshlakovaya diet (tea, juice, broth) as well as a chair in the first days after birth should be absent. Only on day 7 after the laxative can go to the bathroom in a large, and the push is prohibited.
It is not removed stitches, and later in the week for at least the crotch requires very careful care, each visit to the toilet to wash it under running water from front to back, and then to dry the skin carefully. Gaskets need to change frequently, every hour and a half later, the wound is required dryness.
Significant gaps in childbirth, healing that lasts a long time, can be confusing to 3 weeks after birth.
Breaks during childbirth to avoid
How to prevent ruptures during childbirth?
You do not always divide the perineum is inevitable, with the help of special exercises, massage of the perineum prior to delivery, you can reduce the risk of such complications to a minimum.
In most cases, ruptures occur during labor due to unprepared to leave the crotch, not elastic and malorastyazhimoy.
Massage of the perineum
One of the most effective means of preparing for childbirth perineal massage is crotch. This is especially significant for those who have suffered in past generations, or incision of the perineum breaks, the remaining scar stretching can be bad, and the gap is on it.
Start a massage can at any stage of pregnancy, but in early enough to do it once a week, and by 32 weeks, and it can be done once every 3-5 days. Immediately prior to delivery, you can already do every day.
If you have a period now coming to birth, and you do not even begin to massage, do it for a week every three days a week through the day and then daily until delivery.
The best time for a massage – an evening, and the best assistant – your husband. Self hard tummy hurt.
Massage made ??with natural oils such as olive, or even sunflower.
Hands should be clean, wash them with soap and water, then brush with the perineum and labia oil. The vagina is sufficient to introduce two fingers no deeper than 2-3 cm, they need to easily push, swinging on the back wall of the vagina toward the rectum, tingling, and tension suggest that everything is done correctly.
The back wall stretched for 2-3 minutes and let go, and then repeat the exercise again, and so for 5-10 minutes. At the moment of tension needed to learn to relax, do not pay attention to this feeling, this practice will be very valuable at the time of delivery.
At the end of the massage the perineum again treated with oil, do massage the labia minora, they are often torn during delivery, and give them the flexibility now can not hurt.
Exercises to stretch the muscles and ligaments of the perineum
In order to do home exercises for the crotch, do not require special equipment.
You can use the chair:
– Stand near the back of the chair, sideways to it, using it for support and balance. Raise and to give first one and then another leg to the side, the maximum distance for you, 6-10 times.
– From a similar position bend your leg at the knee and lift up to the stomach, 5-6 times for each leg.
– Keeping both hands on the back of the chair, slowly squat down until it stops, spreading her knees apart, popruzhinte. Repeat 5-6 times or as much as you can without much fatigue.
– This exercise will require the retention equilibrium. Sit down on his haunches, extend the leg to the side. Transfer your body weight first on one foot, then on another, his hands holding the balance.
Some postures should do their usual.
– Sit in the tailor’s posture (legs crossed in front of him)
– Pose “butterfly”, pull the heel to the perineum, while in a sitting position, knees in a pose reminiscent of butterfly wings though.
– Use in everyday life stance “on the heels of” kneel, connecting them, and get back on their own heels.
– It is possible to diversify, spreading foot and sat on the floor between your heels.
– Very useful for washing the floor, squatting, and often just sit on his haunches.
Very important: you must be psychologically prepared to leave, do not be afraid of anything, and we must listen carefully to nurses, even if it will be very painful and frightening.
Then the risk of injury to you and your baby will be much less.