Cervical rupture refers to gynecological complications that require emergency medical care. In case of its absence, a fatal outcome is possible. Let us consider the violation in more detail, identify its causes, provoking factors, methods of treatment.
Classification of cervical ruptures
To begin with, it should be noted that the gap can occur independently, for various reasons. But more often it happens with various surgical interventions on the reproductive system and during delivery. Spontaneous rupture can be provoked:
- Weak stretching of the cervix in labor (occurs in primipara after 30 years ).
- Excessive stretching during labor is the extensor position of the fetus, rapid delivery, large fruit.
- Prolonged compression of the uterus because of the narrow pelvis - a violent rupture occurs as a result of the vaginal delivery that helps to speed up the appearance of the baby:
- forceps delivery;
- vacuum extraction .
In addition to classification according to the type of development (violent break and spontaneous), there is also a division according to the severity of pathology. So, it is accepted to allocate 3 degrees of a rupture of a neck of a uterus. Each has its own clinical picture. In this case, the symptomatology of the disorder is similar. Because of this, the doctor can only accurately determine the degree, after examining the genital organ.
Cervical rupture of 1 degree
The rupture of the cervix of the 1st degree during childbirth develops often as a result of noncompliance with the doctor's instructions. Often this happens if a woman is not pushing into a fight. At the same time there is an increase in internal pressure, because of the baby's progress along the birth canal. This degree is set if the gap does not exceed 1 cm. It is located more often on one side.
The clinical picture at small ruptures can be expressed weakly. Often physicians talk about the asymptomatic course of this type of pathology. Especially when the gap does not exceed 10 mm. The main sign in this case is bleeding from the vagina. With time, its volume may increase. The woman experiences painful sensations in the bottom of a stomach or belly, skvatkobrznogo character.
Cervical rupture of 2nd degree
The rupture of the cervix of the 2nd degree during childbirth develops when the fetus does not correspond to the volume of the pelvis. This is possible if the anthropometric parameters of the infant are incorrectly established during ultrasonography. Because of this, doctors wrongly choose the tactics of delivery, which leads to a rupture. At this degree, the gap does not exceed 2 cm. In this case, it is localized only in the region of the uterus, without affecting the vaginal part.
Cervical rupture of 3 degrees
Obstetric rupture of the cervix of the third degree is characterized by involvement of the vagina in the pathological process. In this case, the gap completely merges with it, there is no clear boundary. This type of violation is characterized by strong, abundant discharge from the genital tract, often with large clots. Other symptoms include:
- copious cold sweat;
- pallor of integuments and mucous membranes;
- lowering blood pressure;
- increase in the number of heartbeats.
Causes of cervical rupture
In most cases, the cervical rupture during labor was triggered by a violation of the technique of performing the rhythm-releasing manipulations. However, this can happen because of the circumstances associated with the condition of the genital organ. Among the main causes of the pathological condition of physicians are:
- decrease in elasticity of cervical muscular structures - characteristic during childbirth after 30 years;
- presence of scars , inflammatory processes, which are reflected on the neck;
- anomalies of labor - incomplete cervical dilatation, mismatch of fetal size of pelvis;
- Rapid births - the phase of exile lasts only a few minutes;
- large head size in fetus, body weight more than 4 kg.
Cervical rupture during childbirth
At a delivery the pathology of a similar sort is fixed not often. It provoked by excessive stretching of the edges of the pharynx of the uterus, an increase in the diameter of its outer opening. As a result, the load on the neck increases, and its integrity is violated. Rapid elimination of pathology eliminates negative consequences. Often, with a large gap, decisions are made about conducting an emergency cesarean section.
Postpartum rupture of the cervix is subject to suturing in the delivery room. Sealing is carried out using special, bioresorbable threads. Untimely assistance is fraught with the development of uterine bleeding, which can lead to a fatal outcome of the mother in childbirth. To reduce the time of care, anesthesia is not used.
Cervical rupture during sex
Rupture of the uterus during sex is possible, but in practice this happens rarely. It occurs when a violent, passionate intercourse, with a deep penetration. Traumatisation of the neck leads to the development of bleeding. At the same time, a woman feels a sharp deterioration in her health, weakness, dizziness, headache. The main symptoms of this pathology include:
- Cramping hurts in the lower abdomen, in the inguinal folds;
- the appearance of blood from the vagina (sometimes in an insignificant amount);
- painful sensations in the lumbar region.
Symptoms of cervical rupture
A rupture of the cervix of the 2nd degree and small size can not be clinically manifested. In this case, the patient notes a certain deterioration in overall well-being. Blood from the genital tract is practically not excreted, in some cases, women can mark bleeding. They often connect them with a change in the hormonal background and do not attach importance to them. However, as the situation progresses, the situation worsens.
If the gap in size exceeds 1 cm, there is a uterine bleeding, which causes the doctor to address. In this allocation have blood clots, which indicate a partial accumulation of it in the vaginal cavity. Under the influence of body temperature, blood coagulates and partially exits outward in the form of blood clots. In addition to excretions, these patients record:
- an incomprehensible weakness;
- deterioration of general well-being;
- excessive sweating.
In order to diagnose the rupture of the cervix, the gynecologist conducts an examination in the chair. At the same time, changes in the size and structure of the uterus are recorded. The organ has swelling, which can partially pass to the vagina. When the rupture occurs during childbirth, convulsive fights appear-unproductive, short-term contractions of the uterus. In the urine, blood may be present, and the patient herself complains of severe burning and pain in the lower abdomen. As a result, pain shock develops:
- nausea;
- vomiting;
- increased sweating;
- pallor of the skin;
- lowering blood pressure;
- rapid pulse.
Cervical rupture - consequences
It is worth noting that it is not always possible to diagnose the cervical rupture in time. The reason for this is the absence of bleeding or its low abundance. In some cases, the doctor can not identify the cervical rupture during childbirth, the consequences of which can be as follows:
- hemorrhagic shock due to bleeding in the late postpartum period;
- the formation of postpartum ulcers, which gives impetus to the development of neck pathology;
- formation of scars;
- ectropion - reversal of the cervix;
- development of an ascending infection - endometritis, adnexitis;
- ICN is a true-cervical insufficiency, due to the failure of the muscular structures of the cervix.
Treatment of cervical ruptures
Treatment of this type of violation is possible only surgically. Sewing of cervical rupture is carried out in all cases of pathology. An exception may be surface cracks, in which there is no blood loss. In severe cases, abdominal incision is performed. Used to remove the hematoma, which is formed during the transition of the rupture to a parameter (adipose tissue).
Pregnancy after cervical ruptures
Often the presence of a cervical rupture in an anamnesis becomes an obstacle to the development of a subsequent pregnancy. This is due to the adhesive process in the small pelvis, which prevents normal ovulation and fertilization. However even the begun pregnancy after a rupture of a neck not always it is possible to take out. The incompetence of the muscles of the uterus can cause premature opening, which causes labor before the due date. Because of this, even a small gap on the cervix during pregnancy is subject to control and observation.
Often the violation can be prevented. So prevention of cervical ruptures includes:
- timely passage of ultrasound;
- implementation of medical recommendations;
- the delivery of tests and the passage of research.
Second birth after cervical rupture
In order not to provoke rupture of the uterus along the rumen during natural childbirth, the second and subsequent deliveries of the doctors are carried out by cesarean. Operative intervention is planned in advance. The optimal time for it is 37-38 weeks of pregnancy. Fetal extraction is carried out through the incision, which is performed at the bottom of the abdomen. The operation is performed under general anesthesia.