Tears during childbirth: how to avoid them, and how to care for sutures if there were tears. Prevention of ruptures during childbirth and care of sutures in the postpartum period

Giving birth to a child is a complex process and does not always go smoothly. Very often, women experience ruptures after childbirth in the perineum, cervical canal, vagina, and even injury to the abdominal cavity. In this article we will look at all the causes and consequences, and what to do in such cases.

Over the past few months, the female body has been preparing for the birth of a baby. It is during this period that a hormone is actively produced, which helps the ligaments and tissues of the skin become more elastic and pliable. Intense estrogen production prepares soft tissues: the cervical canal becomes more elastic, the vagina is softer and the perineal tissues stretch. This is in order to reduce trauma during the birth of a child.

But there are a number of factors that provoke internal ruptures after childbirth:

Women whose age exceeds 30-35 years. The fact is that after 30 years, the elasticity of tissues decreases significantly.
Young mothers who are involved in professional sports. In this case, the elasticity of the perineal tissues is significantly increased.
If the fruit is large.
Impaired dilatation of the cervix.
Incorrect presentation of the fetus.
If instruments such as obstetric forceps or a vacuum extractor are used.
When a doctor or obstetrician provides medical care incorrectly.

Trauma to the cervix

The first reason is premature attempts. This happens as follows: attempts began even before the opening of the cervical canal and the fetus, moving forward, cuts it.

There are 3 degrees of injury severity:

The dissection of the cervical canal does not reach 2 cm in depth.
The second degree is more than 2 cm in depth.
And the most severe degree is rupture of the cervix and the uterus itself.

Minor injuries usually go unnoticed. In case of deep injuries, in most cases, the beginning of pushing causes bleeding and after the birth of the baby it intensifies. But sometimes there is no bleeding.

Treatment is carried out by suturing the damaged areas with absorbable threads and examining the uterus to determine their extent. Complications include inflammatory processes in damaged areas. Antibacterial agents are prescribed for prevention.

If the sutures are not applied or they come apart, then as a result, the cervix is everted and pathological damage to the mucous membrane occurs. In some cases, this is the basis for the formation of malignant tumors.

Another consequence is fetal incontinence, which leads to spontaneous abortion. The solution to this problem is hemming or a pessary.

Perineal dissection

Perineal rupture after childbirth occurs due to the fact that the baby's head presses on the muscle tissue and skin in this area. The reason is insufficient elasticity of the skin in this area.

There are three degrees of depth of perineal injury:

On a small area of skin and mucous membrane.
There is also damage to the muscles of the perineum.
Sphincter dissection.

To avoid this, the doctor makes an incision in the perineum. The indications for this manipulation are:

Risk of injury.
Premature, weak or large fetus.
Presentation of the fetus in the pelvic floor.

In order not to use painkillers, the incision is made at the highest contraction and, as a result, the woman does not feel pain from the incision. The incision is made either to the side (episiotomy) or directly to the rectum (perineotomy).

Treatment is carried out by applying sutures to the damaged area. Here they can use threads that dissolve themselves or those that need to be removed after 5-6 days.

The consequences are suture dehiscence and inflammation if not properly cared for. Wounds take longer to heal and in many cases, the anatomical structure of the genital organs changes.

How long it will take for external tears to heal will depend on how the young mother follows the doctors’ recommendations.

Injury to the uterus

Uterine rupture is often accompanied by severe blood loss. This occurs due to damage to the blood vessels of the walls of the inner lining. Characterized by blood in the urine and excretion. This happens during contractions and is aggravated by their intensity. Characteristic is considered to be severe pain in the abdominal area and, as a result, the navel and around it may turn blue. If help is not provided in time, then in some cases death occurs.

In such cases, it is very rarely possible to save the baby, and if he survives, there may be developmental delays.

Injury to internal genital organs

Premature pushing or if the fetus stays in one place for a long time can cause damage to the vagina during birth. Scars heal completely in case of severe damage within 4-6 weeks, but if the injury is shallow - 2-3 weeks. To prevent infection and the development of inflammatory processes, antibacterial drugs are prescribed.

Vaginal rupture manifests itself as bleeding or hemorrhage under the mucous membrane. They are identified during examination.

They are usually sewn up with absorbable threads, and a common consequence is inflammation in the wounds. The consequences of inflammation are the connections between the walls of the vagina and the bladder or rectum. Blisters or fistulas may form at the junction, and this pathology can only be eliminated through surgery. But these complications are the exception rather than a common practice.

Injury to the abdominal muscles

Another injury can be abdominal diastasis, which is a tear in the abdominal muscles. This is not only a cosmetic problem, it can develop a dangerous condition that will require surgery.

The main reason for this pathology is the load on the abdominal cavity during pregnancy, which leads to stretching of the muscle tissue.

It is quite difficult to return to its previous position. There are a number of reasons for which such an injury occurs: multiple pregnancies, excess weight and polyhydramnios (the load on the abdominal cavity is much higher), frequent pregnancies and hereditary causes (this pathology can be inherited).

At the initial stage, diastasis does not cause discomfort and is only a cosmetic problem. But if left untreated, it can progress to the second or third, but here surgery is already needed. Symptoms:

Abdominal pain when bending over.
Indigestion.
Displacement and disruption of internal organs’ functions.
The abdominal muscles atrophy.
Umbilical hernia.
Problems with the spine.
Problems in subsequent pregnancies and complications during its course.

Injuries in this area of the body at the initial stage can be dealt with at home. A set of exercises designed specifically to solve such consequences will help you with this.

But before you start, consult a specialist! So as not to make things worse for yourself.

Weakness of the pelvic floor muscles

The pelvic floor is also subject to damage after childbirth. This is evidenced by the following signs: urinary and fecal incontinence, pain in the pelvis and perineum, prolapse of the vaginal wall. This is a pretty serious problem, but Kegel exercises can help solve it. If you do them regularly, they will help strengthen your pelvic floor muscles. But regularity is very important. The basis of the exercise is to “teach” muscles to contract and relax. To prevent this pathology, you should start doing these exercises regularly during pregnancy.

Your gynecologist will teach you how to perform them correctly. After the examination, he will select the most effective method.

Recovery

Recovery after childbirth usually takes 10 to 14 days if the stitches are properly cared for. Let's consider the basic rules of care:

If absorbable threads were used to injure the cervix and vagina after childbirth, then no special care is needed.
External damage will require special care as the stitches are applied in layers and removable material is used. After each visit to the toilet, you will need to wash with clean water and potassium permanganate and lightly dry with a towel. Frequent replacement of gaskets will be required. If a woman giving birth is in a hospital, a nurse will treat her.
Removing stitches is an unpleasant procedure, but when the wounds are completely healed, this procedure brings relief.
In the first few weeks, you will need to eat lightly to avoid constipation.

Sutures most often come apart in the first days after they are removed. Therefore, you need to sit down carefully and not make sudden movements. Your gynecologist will tell you how to care for scars upon discharge and prescribe an ointment that will speed up the healing process and soften the skin.

No one can definitely tell you how long it takes for scars to heal, but on average this process takes from 14 days and can last up to 2 months, it all depends on the characteristics of your body. Therefore, doctors most often recommend postponing sex after childbirth for 1.5-2 months to avoid injury to the scars.

Where the tissue is torn, a scar is formed, which significantly narrows the entrance to the vagina, which will cause unpleasant and even painful sensations during sexual intercourse. They can last up to 6 months. Painless poses and softening ointment or lubricants will help you solve this problem.

Lacerations during childbirth are damage to the soft tissues of the birth canal: cervix, vagina, perineum, external genitalia. Most often, ruptures occur during the pathological course of labor, while in primiparous women these complications occur more often than in those who have given birth before.

According to statistics, every sixth woman in labor experiences some kind of damage to the soft tissues of the birth canal. However, the number of perineal ruptures has decreased significantly over the past decades, as doctors have increasingly begun to resort to episiotomy - surgical dissection of the perineal tissue in order to prevent spontaneous rupture during childbirth. Cervical ruptures occur in approximately every tenth woman.

Why do breaks happen?

The causes of ruptures of the soft tissues of the birth canal may be as follows:

Large childbirth(more than 4? kg) or gigantic(more than 5? kg) fruit. With an increased size of the fetal head, the pressure on the tissues of the birth canal increases significantly, which leads to an increased risk of ruptures.

Childbirth with a post-term fetus(birth of a baby after 42 weeks of pregnancy). When post-term the fetal skull bones are no longer as mobile relative to each other. Therefore, when a baby with signs of postmaturity passes through the birth canal, its head cannot be configured, that is, take a shape as close as possible to the shape of the birth canal, due to the displacement of the skull bones relative to each other. Thus, the head has a relatively increased size, and the pressure on the soft tissues of the birth canal increases, therefore, the risk of rupture increases.

Fast and rapid birth. During such births, pressure on soft tissues also increases; in addition, the tissues do not have time to adapt to the pressure exerted on them due to intense labor, so they are more susceptible to damage.

Prolonged labor. During prolonged labor, it often happens that the fetal head is installed in a certain place for a long time and compresses the tissues in this particular area. Due to prolonged compression in this area, the blood supply and blood supply to the tissues are disrupted, as a result of which they are easily damaged.

Incorrect insertion of the fetal head. When the head is inserted correctly (enters the birth canal at its smallest size), which promotes the greatest correspondence between the size of the head and the size of the birth canal, injuries to the fetus and mother are minimized. If inserted incorrectly, the head enters the birth canal with its larger circumference. Its dimensions are larger than the size of the birth canal, and the pressure on the soft tissue increases. In addition, if the head is not inserted correctly, labor becomes protracted.

Scar tissue changes. If the soft tissues of the birth canal were previously subjected to any kind of intervention (for example, in previous births there were tears that required sutures, or surgery was performed on the cervix), then in those areas the normal tissue is replaced by connective tissue, which does not have sufficient elasticity and is not always can withstand the pressure exerted during childbirth.

Inflammatory diseases of the genital organs. When inflamed, the tissues become thinner and more loose. In this state they are very easily damaged.

Premature attempts. The desire to push in a woman in labor arises when the fetal head has already dropped low enough and puts pressure on the rectum. This sensation may occur before the cervix is fully dilated. If you start pushing when the cervix has not yet dilated, the forced impact on the cervical tissue will lead to its rupture.

Diagnosis and treatment

After childbirth, each woman undergoes an examination of the soft tissues of the birth canal. Using special instruments (vaginal speculums and clamps), the cervix, vaginal walls, vulva (external genitalia) and perineum are sequentially examined. If there are any injuries, they are surgically corrected - the tears are sutured.

Examination of the soft tissues of the birth canal is carried out without anesthesia, while the woman in labor feels a slight stretching in the lower abdomen and in the perineal area. If ruptures are detected, surgical correction is performed under local anesthesia. In case of significant damage, which requires a long time to eliminate, the anesthesiologist administers short-term intravenous anesthesia. If epidural anesthesia was used during childbirth (a method in which a pain-relieving drug is injected between the dura mater covering the spinal cord and the vertebrae by an injection in the lumbar region), then during the examination the anesthesiologist can add pain-relieving medicine to the epidural catheter, and all manipulations will be painless.

Unsutured ruptures during childbirth are fraught with the development of postpartum hemorrhage, infection, as well as complications that may develop in the future. For example, unsutured ruptures of the perineum and vagina can subsequently lead to the development of prolapse of the pelvic organs. Unsutured cervical ruptures lead to the formation of cervical ectropion (“eversion” of the cervix, in which the integumentary tissue lining the cervical canal (cervical canal) turns outward; chronic inflammation often develops in this area). In addition, in such cases, during subsequent pregnancies, the formation of isthmic-cervical insufficiency (ICI) is possible. In this condition, the cervix does not sufficiently perform its obturator function and opens slightly, which can lead to termination of pregnancy.

Vulvar lacerations

The vulva is located in the vestibule of the vagina: it is formed by the labia minora and majora, the clitoris and the external opening of the urethra. Vulvar ruptures occur most often in the area of the labia minora and clitoris. As a rule, they are presented in the form of tears or cracks.

Ruptures in the clitoral area are usually accompanied by significant bleeding, since this area has an abundant blood supply. Such ruptures are repaired under local anesthesia (anesthetic is injected into the tissue near the rupture site), and a urinary catheter (soft tube) must be inserted into the urethra. This manipulation is performed so that when applying sutures the urethra is not damaged, since it is located very close to the clitoris.

The resulting ruptures of the labia minora are also sutured under local anesthesia, for this purpose a spray with an anesthetic is used. If the tears are minor, there is not always a need for sutures. Since the tissue in this area is very thin and delicate, sometimes the suturing procedure itself can be more traumatic than a tear.

Sutures made of self-absorbable material are placed in the vulva area; they do not need to be removed - they “fall off” on their own 5–7 days after birth, and a thin scar remains at the site of the sutures, which over time becomes almost invisible.

Vaginal lacerations

The vagina is a muscular tube that runs from the genital slit to the cervix. Most often, birth injuries to the vagina occur in its outer third, that is, closer to the genital slit. The middle and upper third have greater stretchability, so tears in these areas are much less common. Often vaginal ruptures extend to the perineum. Tears inside the vagina are repaired with absorbable sutures and do not need to be removed. Healing occurs quickly, since the vaginal mucosa has a rapid ability to regenerate, that is, renewal.
Sometimes vaginal injuries occur in such a way that its mucous membrane remains intact, but the underlying tissues are crushed. When a blood vessel in the submucosal layer is damaged due to bleeding, a hematoma is formed: the vaginal wall in this area gradually increases and swells. The woman in labor feels a growing feeling of fullness. To stop bleeding and get rid of a hematoma, the doctor needs to make a small incision over the place where the blood accumulates, stop the bleeding and suture the damaged tissue.

Perineal lacerations

The perineum is the area from the back wall of the vagina to the external opening of the rectum. In the perineal area there are muscles, ligaments, adipose tissue, blood vessels and nerves, as well as the rectum. Perineal ruptures are divided into 3 degrees depending on the depth of tissue damage:

with a first-degree rupture, only the skin of the perineum is damaged, the rupture extends to the vaginal mucosa;
with a second-degree rupture, not only the skin, but also the muscles of the perineum are damaged;
with a third degree rupture, in addition to the muscles, the sphincter (circular muscle) of the rectum, and sometimes the rectum itself, is damaged.

Perineal ruptures of the first and second degrees are sutured, as a rule, under local anesthesia or under prolonged epidural anesthesia (if it was performed during childbirth). If the muscle layer is damaged, sutures of self-absorbable material are first placed on the muscles, and then separate sutures of non-absorbable material are placed on the skin: this ensures optimal tissue matching. As a rule, sutures made of non-absorbable material are removed on the fifth day after birth.

If the perineal tears are minor, then self-absorbing sutures can be applied to the skin. Some doctors practice applying an internal suture to the skin, then a very neat, almost invisible scar is formed. In this case, the woman does not experience additional discomfort when removing the sutures; rapid healing will occur due to the abundant blood supply to the perineal area after childbirth.

Suturing of third degree tears is carried out in the operating room under general anesthesia. The main task of the surgeon in case of such ruptures is to ensure the integrity of the rectal sphincter and the rectum itself, if it has been damaged. After this, the integrity of the muscle layer is restored, then the skin.

Episiotomy

Surgical dissection of the perineum for certain indications is called episiotomy. This intervention is most often performed when there is a threat of spontaneous rupture of the perineum, a sign of which is maximum stretching and thinning of the tissue. At the same time, the fabrics become whitish and slightly shiny. This occurs due to the fact that excessive pressure is exerted on the tissue, the blood vessels are pinched and bleeding of the tissue occurs.

If the obstetrician-gynecologist sees that the perineum is about to rupture, then he cuts the perineum slightly to the side of the midline. It is believed that an episiotomy is preferable to a spontaneous rupture of the perineum: a wound with smooth edges caused by a surgical instrument is easier to repair and heals faster than a laceration, often with crushed edges, as happens with a perineal rupture.

Episiotomy is also performed in situations where it is necessary to shorten the second (pushing) stage of labor, that is, to speed up the birth of the fetus. This is necessary in case of acute fetal hypoxia, when for some reason it begins to suffer from a lack of oxygen; with gestosis (a complication of pregnancy, which is accompanied by increased blood pressure, the appearance of protein in the urine and edema), when delaying labor can worsen the condition of both the fetus and the mother, as well as with certain recommendations of an ophthalmologist or therapist. Indications for episiotomy by various specialists are aimed at maximizing the reduction of tension during pushing. In other words, in some situations a woman is not recommended to actively push. This should not be done if you have high blood pressure, cardiovascular pathologies, or increased intraocular pressure.

Suturing a wound after an episiotomy is carried out according to the same principle as suturing perineal tears. First, absorbable sutures are placed on the muscle layer, and then several non-absorbable sutures are placed on the skin, which are removed on the fifth day of the postpartum period.

Cervical ruptures

Based on the depth of damage, there are 3 degrees of cervical rupture:

first degree – the length of the gap is less than 2 cm;
second degree - a gap of more than 2 cm, not reaching the vaginal vault, i.e. to the end of the cervix, the area of its internal pharynx;
third degree - the rupture reaches the vaginal vault or extends to it (in fact, the cervix is torn along its entire length). A third degree cervical rupture is very dangerous, as it can progress to uterine rupture.

First and second degree cervical ruptures are repaired surgically during examination of the soft tissues of the birth canal. As a rule, anesthesia is not required: the tissues of the cervix do not have pain receptors, and the woman only feels a stretching in the lower abdomen during manipulation. Sutures are placed with self-absorbing materials and cannot be removed. With proper tissue comparison, no scars remain on the cervix, and healing occurs within a few days.

In case of third degree cervical rupture, it is necessary to perform a manual examination of the uterine cavity to exclude rupture of the lower segment of the uterus. This manipulation is performed under short-term intravenous anesthesia. The doctor inserts his hand into the uterine cavity and checks the integrity of its walls. If the walls of the uterus are not damaged, a deep rupture of the cervix is sutured. If a rupture of the uterine walls is diagnosed, then abdominal surgery is necessary to examine the site of damage and make a decision on further tactics. Unfortunately, if there is a uterine rupture, it is most often removed, since uterine ruptures are dangerous with life-threatening bleeding. However, if the gap is small and it is possible to stop the bleeding, doctors make every effort to save the organ.

Prevention

The main prevention of ruptures during childbirth is the coordinated work of the midwife, doctor and woman in labor. Depending on the degree of dilatation of the cervix or the level of the fetal head in the pelvis, the obstetrician may ask the woman not to push when pushing is already felt, but to breathe through the contractions, or, conversely, to push at a certain moment. The fact is that with premature attempts, cervical ruptures very often occur. With significant, but not complete dilatation of the cervix, the fetal head begins to gradually descend and presses on the rectum. Thus, the woman feels pressure, but the cervix has not yet fully dilated. If you start pushing at this moment, then such forced advancement of the head can damage the not yet fully dilated cervix. And too early attempts can lead to excessive pressure on the tissues of the birth canal, contributing to their crushing.

If you feel an overwhelming urge to push, but your cervix is not yet dilated, your obstetrician will ask you to “breathe” through the contraction. To do this, you need to take frequent inhalations and exhalations through your mouth (sometimes called “doggy breathing”). Such breathing ensures hyperventilation of the lungs, and excess oxygen enters the blood. As a result, the feeling of pain and fullness is dulled and the desire to push weakens. In addition, concentrating on a certain way of breathing will distract you from unpleasant sensations. If you manage to breathe through the contraction, the cervix will gradually open, and the fetal head will gently move through the birth canal, and cervical ruptures can be avoided.

In addition, during childbirth, the midwife performs so-called perineal protection techniques. At the same time, she gradually stretches the perineum with her fingers so that the tissues “get used” to stretching. When the fetal head is ready to erupt through the genital slit, the midwife performs certain actions to protect the integrity of the perineum. When the head erupts, there is a moment when the midwife also asks the woman in labor not to push, but to breathe through the contraction. This occurs when the head passes through the genital opening with its largest size and additional forces can lead to rupture of the perineum.

Despite the fact that ruptures are prevented during childbirth, measures to prevent this complication must be taken already during pregnancy.

Firstly, if a woman has inflammation of the vagina, it must be treated before childbirth, since inflamed tissues are much more susceptible to rupture than healthy ones. Also, the inflammatory process can lead to the development of an ascending infection (transition of infection from the vagina to the uterus).

Secondly, in order for the perineal muscles to be more elastic and easily tolerate excessive stretching during childbirth, it is recommended to do Kegel exercises. They consist of alternately contracting and relaxing the muscles of the perineum, as when restraining the urge to urinate. With regular exercise, the perineal muscles are strengthened and blood supply to the perineal area is improved. This, in turn, improves tissue trophism, which reduces the risk of damage during childbirth.

Kegel exercises You can start doing it as early as 26–28 weeks of pregnancy. It is best to perform them 2-3 times a day for 70-100 contractions. It is useful to continue the exercises after childbirth: they will help the perineal muscles recover faster.

After the breakup

If ruptures did occur during childbirth or an episiotomy was performed and the damage was surgically repaired, in the postpartum department they treat the sutures on the skin of the perineum and external genitalia so that infectious complications do not develop. If everything is in order, then non-absorbable sutures are removed 4–5 days after birth.

For the speedy healing of postpartum tears, you must follow the following rules:

It is not recommended to sit for the first time, as the stitches may come apart and will have to be reapplied. Depending on the degree and magnitude of the damage, this period can last from several days to two weeks, depending on the type of suture material and the method of suturing.
You should wear cotton underwear and use special postpartum pads or pads made from natural fabrics: they do not interfere with air circulation and thus prevent infection.
It is advisable to use special products for intimate hygiene, because they do not dry the skin and do not cause additional irritation.
Hygiene procedures are recommended to be carried out after each urination and defecation.

During childbirth, the perineum, cervix or labia are often torn. The woman will experience severe pain and bleeding may occur, which will subsequently complicate the process of bringing the baby into the world. It is important that a doctor or midwife is present.

Internal ruptures during childbirth: how they are caused

No matter how well everything goes during the entire period of bearing a child, this does not guarantee that no surprises will arise during the birth process. A woman giving birth on a chair can face various complications.

Internal ruptures are tears in the cervix and vaginal walls. This may be due to premature pushing; during this period, a woman needs to make every effort to restrain herself and not push. When pushing, the cervix is under enormous pressure, and if it is not yet sufficiently dilated and the pressure exceeds the threshold, then the internal tissues literally tear.

Also, ruptures may be related to the physiology or size of the fetus. For the same reasons, ruptures in the vaginal walls occur. During this entire, undoubtedly most painful procedure, the woman may not notice the breaks.

The doctor's task is to thoroughly examine and apply stitches to the damaged areas. As a rule, these are self-absorbing sutures, which facilitates the healing process.

The main task after such injuries is to maintain complete hygiene and avoid putting stress on the affected area.

It includes:

Quite a long period of abstinence from sex, 1-2 months;
Any stress on the abdominal area (sports, lifting heavy bags and even constipation);
Do not make sudden movements, especially in the first weeks.

To prevent complications after suturing and prevent inflammation, doctors may prescribe antibacterial drugs. It must be remembered that if a woman is going to breastfeed her baby, she should take medications with caution.

Causes of perineal rupture after childbirth

Childbirth does not always go smoothly: sometimes the baby lies too low, he is too large, or the vaginal tissue is not elastic enough, which leads to injury to the perineum. If the perineum protrudes, changes color and begins to swell, there is a threat of its rupture.

This complication during childbirth is considered the most common - 35% of women (especially during the first birth) experience a perineal rupture.

In addition to the main reasons that can lead to perineal rupture, secondary factors can also be identified. These include: rapid labor, scarring of tissue after previous ruptures (for repeat mothers), incorrect assistance with pushing.

Most often, ruptures occur when the baby's head emerges through the perineum. The baby, or rather his head, moves along the birth canal and begins to compress the veins located in it. The movement of blood becomes difficult, the resistance of the bloodless tissues of the perineum increases, which leads to rupture.

Types of breaks:

Spontaneous - occurs during childbirth without any intervention;
Violent - can be provoked by a certain action of personnel or interference in the course of childbirth.

During complicated childbirth, ruptures can first affect the vagina and then move to the perineum of the woman in labor. When ruptures occur, bleeding often occurs, which is aggravated if the pregnant woman suffers from varicose veins.

Ruptures after childbirth: prevention and treatment

You can avoid ruptures by carefully monitoring the birth process. At the first hint of the possibility of rupture, the doctor delivering the baby decides on surgical intervention. To prevent ruptures, an episiotomy is performed, that is, a surgical incision in the perineum.

Indications for episiotomy:

Possibility of perineal rupture;
Green Waters;
Post-term pregnancy;
Breech presentation of the baby;
Childbirth that began prematurely;
Oxygen starvation in a child.

The perineal incision procedure occurs during pushing and no anesthesia is used when cutting the skin. After the baby is safely out, the woman gets stitches. If the vagina is torn, the muscle is sutured with special threads, which will dissolve on their own after a while. A stitch is made on the skin with threads, which must be removed after 5 days.

The tissue junctions can become inflamed and swollen, so a woman is not recommended to sit down for about 8-10 days, with the exception of the toilet.

If the outer seam turns red and fluid comes out of it, you should immediately consult a doctor for first aid.

How long does it take for internal sutures on the cervix to dissolve?

Internal seams are made using self-absorbing threads. Such threads are made from the intestines of sheep or cattle. They are used for suturing the uterus after a caesarean section or the cervix for ruptures during childbirth. It is believed that 90 days are needed for complete resorption. The threads may fall off earlier, pieces may be noticeable on the underwear, but still you should not violate the terms prescribed by the doctor and follow the rules.

In the first couple of weeks after surgery to stitch up incisions (tears), a woman will experience discomfort; this is normal. Twitching, pulsation, and aching pain may occur in the perineum. But if these sensations continue later, you should immediately consult a doctor.

Reason to go to the hospital:

Heaviness in the uterus and vagina;
Continuous pain;
Purulent discharge;
Temperature.

A woman who has given birth with internal sutures needs not only to monitor the hygiene of the perineum, but also to treat the sutures with healing ointment and disinfectants - chlorhexidine, potassium permanganate solution.

How ruptures occur during childbirth (video)

Failure to comply with hygiene and the rules prescribed by the doctor can lead to the fact that the sutures placed after childbirth may come apart. If the tissue junctions hurt, become inflamed, and fluid is released, you should immediately consult a doctor for treatment recommendations.

The content of the article:

How to give birth without ruptures is of interest to all pregnant women who are planning to give birth naturally. Let's look at why ruptures appear and how they can be prevented; is childbirth really possible without ruptures and incisions, or is no one immune from this?

Lacerations during childbirth are a complication that often occurs during labor. It is not possible to predict how the process will proceed, so none of the women giving birth is immune from such injuries. But there is no need to panic! If you gain timely knowledge about what gaps are, what to expect from them and how they can be prevented, then it is possible, if not to avoid this problem, then at least to significantly mitigate its consequences.

What are the gaps: types and degrees

Damage during the delivery process can be spontaneous or caused by medical intervention. In general, there are several types of such injuries. Among them are gaps:

Crotch;
vaginas and vulvas;
cervix;
uterus.

A rupture of the symphysis pubis may also occur during childbirth.
Let's look at each type in more detail.

Perineal rupture during childbirth: degrees and consequences

In most cases, it is this area that is susceptible to damage. They appear when the baby’s head puts pressure on the insufficiently elastic tissue of the perineum. You need to listen to the midwife, behave in accordance with her recommendations, then it is possible to go through childbirth without ruptures.

Such an injury can be of three degrees of complexity:

1. Small tears after childbirth in the perineal area, when only the skin or the posterior commissure is damaged (rupture of the commissure during childbirth), possibly a small segment of the vaginal wall.

2. The second degree is characterized by injuries to the muscles of the perineum, that is, pelvic floor tissue is added to the overall picture.

3. Third degree damage can be incomplete, complete or central. In the first case, among other things, the sphincter is affected. In the second, even rupture of the rectum during childbirth is possible. A central rupture is rare. It represents an injury to the posterior vaginal wall, perineal tissue and pelvic muscles, while the sphincter and commissure remain intact.

Of course, the third degree is considered the most severe type of injury in obstetrics. In this case, qualified medical care is needed. All these troubles and problems: from rupture of the posterior commissure during childbirth to damage to the intestinal wall can lead to the following consequences (except pain):

The occurrence of bruising and swelling in the area where the stitches are located;
urinary disturbance;
suppuration of sutures, their divergence;
the appearance of a scar in the perineal area;
lack of sensitivity at the site of the rupture;
dysfunction of the rectum.

All consequences can be avoided if you engage in the prevention of ruptures during pregnancy, which will be described below.

Rupture of the vagina and vulva during childbirth

Vaginal trauma can occur due to the fact that a woman begins to push ahead of time. Also, the cause of the rupture is the prolonged presence of the baby’s head in a motionless state in one place. This damage is manifested by bleeding. Or it is discovered during a doctor’s examination of the birth canal. In this case, the rupture manifests itself by hemorrhage under the vaginal mucosa, that is, a hematoma is formed.
Injuries to the vulva are mainly tears of the labrum during childbirth.

Cervical rupture

Such damage occurs if the baby is too large, during rapid labor or during obstetricians’ manipulations to speed up labor. The injury is also divided into three degrees.

Cervical ruptures during childbirth of the 1st degree: the size of the damage does not exceed 2 centimeters, localized either on one side or on both.
- Cervical tears during childbirth of the 2nd degree: the gap is more than 2 centimeters, but the walls of the posterior part of the vagina remain intact.
- Cervical ruptures during childbirth of the 3rd degree: the tear reaches the vaginal vault and affects it.

The first and second degrees of cervical ruptures are assessed by doctors as uncomplicated. And the third degree is already considered complicated. With such a rupture, treatment may require opening the abdominal cavity. The operation is necessary to close the damage directly at the site of its formation.

Why are ruptures during childbirth of this nature dangerous? Such injuries (cervical ruptures) entail more serious consequences than tears of the perineum or vagina. Among them:

Inflammatory diseases of the cervix;
postpartum endometritis;
hemorrhage into the fatty layer that is located around the uterus;
hemorrhagic shock.

Such problems can arise if the rupture was not identified, due to incorrect sutures or improper treatment.

Uterine rupture during childbirth

An injury as serious as uterine rupture is rare. And this type of damage is the most severe. It can occur for many reasons: from a large fetus to unnecessarily stimulating labor. It is localized either at the bottom of the uterus, or on its body itself, or on the lower segment. Very rarely, but still there is a complete separation of the reproductive organ from the arches. The rupture itself can be in the form of a crack, and can also be complete or incomplete.

When a uterine rupture does occur after childbirth, doctors do everything possible to ensure that the process (birth) is completed as soon as possible and with a successful outcome. If a full type injury occurs, then surgical delivery is performed. In this case, the baby is taken out of the mother’s womb, the reproductive organ is stitched together, and the bleeding stops.
Of course, such an injury entails serious consequences in case of untimely detection, including the death of the fetus from oxygen starvation.

Rupture of the symphysis pubis during childbirth

The pubic symphysis is a semi-movable connection of the hip bones, a kind of semi-joint. Discrepancy rather than rupture is more common.
During childbirth, a discrepancy of up to 1 cm is considered normal (that is, the distance between the pubic bones is 1 cm). If it is more, then this is a pathology that requires difficult treatment.

Rupture is more dangerous. But an experienced doctor can always predict the possibility of its occurrence and, accordingly, prevent it.

If an injury does occur, then errors in treatment are unacceptable, because they can lead to disruption of the musculoskeletal system, since the pelvic bones themselves “do not know how to fuse.”

How are tears stitched after childbirth?

After the birth of a child, the birth canal is always examined by a doctor using the necessary instruments. If there are ruptures, they are sutured under local anesthesia (if the injuries are serious, intravenous anesthesia is given).
It is important to match the edges of the gap as accurately as possible. The sooner after the birth of the baby and the better the rupture is sutured, the fewer bad consequences the damage will entail.

Proper care of seams is also important. Mostly self-absorbable ones are used, the removal procedure of which cannot be endured.

In addition, it must be remembered that ruptures that have not been sutured are fraught with bleeding, infection of the birth canal and other complications.
Incisions during childbirth: types and methods

Incisions are made mainly for the following reasons:

If there is a threat or prerequisites for spontaneous ruptures;
with a breech presentation of the child;
when it is necessary to reduce the time of expulsion of the fetus;
poor elasticity or developed muscles of the perineum;
there is a need to use forceps or a vacuum extractor.

There are other reasons, but such a procedure is always carried out only if it is appropriate.

How is the incision made during childbirth?

In this process, 2 types of dissections are applicable:

1. Perineotomy is a midline incision of the perineum.
2. Episiotomy - an incision during childbirth diagonally from the vagina.

The procedure is carried out using sterile operating scissors while pushing. Basically without anesthesia - at the height of the contraction, when the incision is made, sensitivity is lost. Before the operation, treatment with antiseptic agents is carried out. The incision is sutured immediately after the “baby spot” is delivered.

Causes of ruptures during childbirth

There are many factors influencing the occurrence of birth injuries such as ruptures. These include:
large child;
post-maturity;
inexperience of the woman in labor and her incorrect actions during childbirth;
childbirth after caesarean section;
rapid or prolonged labor;
woman's age after 35 years;
incorrect insertion of the baby's head into the birth canal;
old tissue scars;
inflammations and infections of the genital organs (especially chronic);
untimely attempts;
negligence of health workers;
physiology (high crotch).

As you can see, many factors can be eliminated if you know how to avoid ruptures during childbirth, what preventive measures to take and how to behave during labor.

Prevention of ruptures during childbirth

Statistics on birth ruptures suggest that up to 15% of women have experienced such birth injuries. In order not to fall into the risk zone, you need to know how to prepare the body for childbirth without ruptures. To do this, preventive measures should be observed. For example, these:

In order to give birth without tears and incisions, you should prepare for the birth of your baby even before pregnancy. And during the gestation period, you definitely shouldn’t forget about this. The risk of injury is significantly reduced if the expectant mother engages in simple pelvic muscle training, including the well-known Kegel exercise.

One of the main factors in the absence of damage is massage from ruptures during childbirth. It is performed in the perineal area. You can do it yourself, but only after consultation with a gynecologist. There are special oils against ruptures during childbirth, but olive, calendula, almond and others can also be used for massage.

The doctor may also prescribe suppositories for ruptures during childbirth. For example, Buscopan, which soften the cervix well, which means they sufficiently reduce the risk of rupture.

During childbirth, a guarantee that the process will take place without injury is obedient behavior during contractions and following the recommendations of the midwife. You cannot push if the doctor forbids you to do so - tissue rupture may occur.
It is also important to remember the right emotional mood. Everything will be fine!

Treatment of ruptures during childbirth at home

Often, the doctor prescribes Levomekol, a healing antimicrobial ointment, for home care for sutures in case of ruptures after childbirth. Judging by the reviews, it really helps a lot.
Painkillers are also prescribed if the injuries were serious and the woman is bothered by pain. And laxatives, since the process of bowel movement can be painful. Of course, all appointments are made with breastfeeding in mind.
Personal hygiene and timely cleaning of sutures play an important role in home treatment. Proper care of the perineum after childbirth is imperative.

Questions and answers

And a few more questions that concern many mothers who are faced with the problem of breakups.

1. How long does it take for tears to heal after childbirth?

It all depends on the nature, depth and type of damage. Most pain and discomfort go away within an average of three weeks. Full recovery lasts up to six months (all individually).

2. How long can you not sit after ruptures after childbirth?

One or two weeks. The nature of the injury is also important here. But, for example, you can use (only carefully) a seating pad. As healing progresses, it is allowed to sit on one buttock.

3. How long does it take to bleed after a ruptured birth?

With proper and timely suturing of the injuries, everything goes the same as with a proper birth without ruptures.

4. How to give birth without tearing?

It is necessary to prevent such injuries. And preferably before pregnancy.

5. How long does it take for an incision to heal after childbirth?

Within two weeks - one month.

6. How to wash after childbirth with ruptures?

For hygiene you only need warm running water. And it is better to do this every 2 hours. And, of course, after visiting the toilet.

7. When does it become possible to drive a car with a tear after childbirth?

Then, when you can sit normally and correctly.

Tears during childbirth are not uncommon. It is important to know that they can be prevented. And if an injury does occur, qualified medical assistance will help solve the problem without complications or negative consequences.

When do gaps appear and why? How to avoid pain in the postpartum period and how to return to normal life?

Before talking about internal seams, every woman needs to know anatomy of internal female organs, which are involved in the process of childbirth, where, in fact, a rupture can occur.

Childbirth involves the uterus, cervix, vagina, and perineum. If the birth goes well, must not be. This is a serious complication; such cases are very rare; during childbirth, the doctor can notice signs of a threatening rupture and do it in time.

Perineal rupture refers to external ruptures, and the tactics for managing external ones after childbirth are different, since suturing perineal tears refers to sutures that are sewn with non-absorbable material (silk, polypropylene) and then removed.

Mostly we'll talk about ruptures of the cervix and vaginal walls. It is these gaps that are sutured with internal sutures, which are then not removed, but resolve on their own.

Causes of internal gaps

The most common causes of internal ruptures include:

large fruit;
inelasticity of fabrics;
fast or rapid labor;
narrow vagina;
inflammatory diseases of the vagina during pregnancy;
childbirth after abortion.

The physiology of normal childbirth involves prolonged dilatation of the cervix, for 12 hours or more, especially in first-time mothers. In those women who give birth repeatedly, as a rule, the dilation of the cervix occurs faster.

Therefore, in the first stage of labor, when the birth canal is being prepared and the cervix is opening, supervision by a doctor is necessary.

If the cervix is not fully dilated and the woman begins to push prematurely, a cervical rupture may occur. The doctor’s task, if he sees premature attempts, is to “restrain” the woman from this wrong step. For the same reason, the walls of the vagina are torn.

Internal breaks may not be visible immediately after birth, for this, after separation of the placenta, the doctor examines the cervix and vagina in the speculum.

The procedure is painless, but necessary so that even small cracks are sutured and do not cause trouble. Any wound that is not sutured can become inflamed after childbirth.

The procedure for suturing cervical ruptures painless. This is how nature protected the woman after childbirth from unpleasant sensations. When suturing the vaginal walls, pain may occur, because the vagina is rich in nerve endings. In this case, the doctor numbs the injured vaginal walls with novocaine or lidocaine.

Catgut– the most commonly used suture material for internal seams. These are natural threads made from sheep intestines. Its structure is similar to human tissue, and therefore after 7-10 days it can dissolve on its own, this happens under the influence of enzymes in the woman’s body.

Can be used for suturing semi-synthetic threads such as vicryl, PHA, caproag, which take a little longer to resolve, within 30-60 days.

Caring for internal seams

There is no care for sutures as such, but a woman needs to know that in the postpartum period, discharge will be released from the uterus for several weeks - lochia, which make it difficult to create sterile conditions in the suturing area. It is also not possible to apply a sterile bandage.

The tactics of managing a postpartum woman in the postpartum period have changed. If previously a woman who had internal stitches was allowed to get up after giving birth a few days later and was allowed to feed the baby on the third day, now the situation is different.

Today, the management of women in the postpartum period with stitches is almost no different from healthy women. The presence of a woman and a child together immediately after childbirth presupposes the active behavior of the postpartum mother.

If there are stitches, then you need to remain in a lying position for at least 2-3 days, so some assistance from medical personnel may be required.

That's why precautions must be taken so that the seams do not come apart (especially deep ones) and do not fester. Sitting as usual is also not recommended; it is advisable to sit reclining, or sit on one of the buttocks. This precaution is necessary for a month or a little more.

You can start no earlier than after two months. This makes it possible for the torn walls to heal well and restore their elasticity.

If a woman begins to be sexually active before this time, a situation may arise where infection of tissues that have not completely healed occurs with all the ensuing consequences.

The child should be fed only in a lying position, and should be fed while standing or lying down. It is advisable not to lift heavy objects during this period, as this may cause the internal seams to separate. You shouldn't even lift a child, especially if you have a large baby.

The main condition for self-care of internal seams remains personal sanitation and hygiene. Until the tissues are completely healed, You need to shower 1-2 times a day, under no circumstances take a bath!

It is necessary to use gaskets, immediately after childbirth with special postpartum ones, and then daily, which need to be changed more often to ensure dryness of the wounds.

Shapewear women who have internal seams too It is contraindicated to wear it for one and a half to two months. The fact is that such underwear creates excessive pressure on the perineum and vaginal walls, and this, in turn, interferes with the rapid healing of the sutures.

Behavioral tactics after childbirth

It is necessary to understand that The usual rhythm of nutrition for a woman after childbirth is not suitable.

Due to the fact that all intracellular water rushes into the mammary glands, a restructuring of the body’s functioning is taking place; in the first days after childbirth, postpartum women may experience. Therefore, even women who do not have stitches prescribe a diet: more liquid, broths, less bread, and so on.

All this needs to be known and remembered by a woman who has stitches. Unwanted constipation may place stress on the seams, which may come apart.

If you see that there is no stool for 1-2 days, drink a laxative or do an enema. Immediately after emptying, you need to wash the external genitalia with warm water and an antiseptic solution, because the lower edge of the vaginal wall, where there may be stitches, comes into contact with the perineum.

If the internal ruptures were deep and multiple, the doctor may prescribe antibiotics in the early postpartum period, this is done to prevent complications. Complications may occur in the postpartum period, in which case you should immediately consult a doctor.

When should you not postpone a visit to the gynecologist?

if there is pain inside the vagina that does not go away;
heaviness appears in the lower abdomen and pain increases;
suddenly developed a high temperature;
Purulent discharge appeared from the vagina.

Sometimes another cause can cause these symptoms, but if you had internal stitches, you need to rule out the underlying problem! All these symptoms, to one degree or another, indicate either inflammation of the sutures or their divergence. The doctor should prescribe you treatment, which can be either local, with treatment of sutures, or general.

But you need to know: Even if you don’t have any complaints, you still need to contact an antenatal clinic. Immediately after childbirth, it is difficult to assess the condition of the sutures in cosmetic terms, because there is tissue swelling.

The doctor should examine the internal stitches and pay special attention to the condition of the cervix. If the sutures on the neck are not fused correctly, this may cause complications in the future.

Firstly, a rough formed scar can result because the cervix needs to be tightly closed during pregnancy.

And secondly, a rough scar during childbirth may prevent the cervix from opening completely, which can also lead to dire consequences. Therefore, only an examination in a gynecological chair a month after giving birth will allow you not to worry about your future or make a decision - to have the old scar excised and new sutures applied.