Bleeding from external genital parts of the vagina and cervix

The reasons. Not only the uterus is the source of bleeding in succession period. It often happens that the uterus is well cut, has a spherical shape, its bottom is located below the navel, but nevertheless stands out from the vagina to the outside so much blood that the life of the pregnant woman is exposed to great danger.
Whence comes this blood issue?
Almost every birth in periodama accompanied by those or other infringements of the intact tissue soft generic ways, and linked to this is always a degree of blood loss. There are a variety of injuries from small cracks and abrasions to deep lesions with infringement of an integrity of the blood vessels. Sometimes breaks the mucous membrane of the vagina and part of the pelvic muscles continue along the border rear and side walls to the parametrium in the field of cavum ischio-rectale. Sew up this huge gaping slit seems difficult because of the difficulty of sutures in the depth of such a gap and accurate recovery in anatomic correlations tissues. Not are less severe damage to the anterior vaginal wall, reaching symphysis ossium pubis; in these cases, small labia appear separated from the large and clitoris - as if hanging on a thin stem.
Among the factors contributing to the violation of the integrity of the soft tissues of the generic ways include: 1) reducing the elastic properties of soft tissues (muscle and connective tissue system), forming a wall of the birth canal; 2) deviation in the anatomy of the perineum (high crotch), in the architecture of the pelvis and its amount; 3) narrow basins with an acute angle; 4) the value of the inclination angle of the pelvis, and therefore is the location of the genital slit (big inclination angle of the pelvis unprofitable); 5) failure to discharge of amniotic fluid, causing an increase in the number of cervical tears; 6) the type of presentation (rear view occipital, prednisolone, frontal, rear), the subsequent birth of a head when the pelvic presentation; 7) the value of (excessive) and head; 8) the speed with which cut through the head; 9) the method of delivery (spontaneous labor, methods of deducing head); 10) the position of the body of the woman, and so on
However, taking into account all these factors, it is impossible not to pay attention and the technique of delivery.
Clinical experience convinces us that the appearance of gaps in the perineum and vagina in most cases is connected with the flaws in the technique of rendering of the manual tool in the head previa, in other words with the so-called reception "protection crotch". Under the "protection crotch" you should understand such actions of the doctor or midwife who spend births, which is directed to regulation of speed of the translational motion of the head of the fruit and prevent the undue extension of her and eliminate the maintenance of the perineum. In other words, the crown should be carried out in the best size, i.e. the lowest circle, though slowly and outside attempts.
Unfortunately, this rule is often neglected.
Untimely and sometimes unnecessary support crotch, wrong napravlenie skin of the vagina generic inside of the tube with the aim ostensibly to facilitate and even to accelerate the cutting head only lead to trauma generic tube and often to such serious damage, which does not happen even in the so-called "street childbirth".
The most profound and extensive damage to soft generic ways most likely to occur when the operational delivery (forceps, rotating, removing and etc.). The percentage of damage soft generic ways, driven by a number of authors, not quite accurate, since it is usually recorded significant violations of the pelvic floor and vagina, and minor injuries often visible.
Before the advent of the cutting head, the doctor must decide whether it has the necessary elongation of the tissues that make up the crotch.
Knowledge of the properties of tissues allows to take appropriate measures to prevent rupture of the perineum during childbirth.
Characteristics of tissues of the perineum in childbirth doctor is based on the analysis of previous birth (if the mother has powerseraya) and based on the survey. Sharp bulging crotch, its height, whitening of skin, insufficient blood supply due to heavy strain, large head, perineostomy in the preceding childbirth, inferiority General somatic development mothers and especially sexual sphere - these are the signs by which is established the need for surgical expansion muscular ring. The presence of these features D. O. Ott highly sought to prove the feasibility of preventive incision in the perineum (perineostomy). Preventive perineostomy allows you to keep the pelvic floor muscles and to prevent further serious complications.
Breaks crotch and vaginal tube cause heavy bleeding occurs, only with a deep tissue damage. Shallow breaks vagina without disturbing the integrity of blood vessels are accompanied by slight bleeding. As in those, and in other cases, you need stitches to better contact torn areas of tissue (figure. 113, 114, 115, 116, 117). Only small surface scratches can be left unembroidered and lubricated iodine tincture.


Fig. 113. Mending the gap crotch.
a - stitching shallow break; b - stitching deep divide.

Fig. 114. Of perineum third degree.
1 - columna rugarum auterior; 2,7 - the upper ends of the gap; 3 - rear spike; 4 - the mucous membrane of the rectum; 5 - sphincter ani; 6 - the anus.

Fig. 115. Exposure of a complete rupture of the perineum.
1 - the upper end of the gap; 2,6 - back spike; 3, 8 - dispersed parts of the anus; 4 - columna rugarum auterior; 6 - columna rugarum posterior; 7 - fiber broken sphincter.

Fig. 116. Stitches on the intestinal wall.
AA - a rupture of the anus; SS - back spike.

Fig. 117. Stitching a complete rupture of the perineum. Stitches on the muscles of the perineum and mucous membrane of the vagina.

The recognition. Damage of the birth canal are identified by a visual inspection. After the birth of the placenta must be carefully examined external genitals, vagina and perineum. Of perineum usually starts with a back wall of the vagina and extends towards the anal opening. In rare cases, the damage crotch starts from the centre (the so-called Central of perineum), forming an artificial hole, through which is born fruit. Sometimes there are breaks individual vessels in the tissue, somewhere above the arches, while the vagina and cervix breaks are not visible. When heavy bleeding from the vagina with intact external genital parts, as well as after surgery inspection must be made in the mirrors. Often minor exterior damage when viewed with the help of mirrors are propagating in the depth of the birth canal.
Bleeding from external genital parts. Wounds of vascular plexuses in the clitoris and around the openings of the urethra may be causing quite heavy bleeding. Especially heavy bleeding happens if there are any abnormal changes, such as varicose veins. As the tissue in that area is very sensitive, stitching damage shall be made under local anesthesia 0.25% solution novokaina.
Because of the extremely plentiful network of blood vessels in this area seams should be applied not very often using a thin steeply curved needle and thin (no 2) catgut. In some cases, need to take into the seam and deeper underlying tissues, up to the periosteum. When stitching damage along the urethra seams must be applied after the introduction of the urethra catheter (to avoid narrowing its clearance).
Breaks the perineum and vulva severe blood loss accompanied rarely. The exceptions are the breaks of the third degree, which can lead to significant bleeding. Treatment in these cases, only surgical.