Female genital trauma during sex: causes, symptoms, treatment. Rupture of the cervix during childbirth, consequences and treatment Rupture of the cervix consequences

Violation of the integrity of the cervix during childbirth, with the formation of a wound with torn or linear edges, is called a rupture of the cervix and is included in the list of obstetric injuries. According to various authors, ruptures of the cervix occur in 6-15% of cases.

Causes

There are many reasons for cervical rupture:

inflammatory diseases of the cervix;
history of surgical treatment of cervical pathology (diathermocoagulation, operations on the cervix);
cicatricial deformity of the cervix after intrauterine manipulations (abortion, curettage, previous birth with cervical ruptures);
overstretching of the neck in childbirth with a large fetus or with extensor insertions of the head;
impetuous and quick labor;
protracted labor (prolonged standing of the presenting part in one plane of the small pelvis, as a result of which the neck is compressed, and the blood supply in it is disrupted);
instrumental childbirth (the imposition of obstetric forceps, vacuum extraction of the fetus, manual separation and separation of the placenta, obstetric manuals for breech presentation);
fruit-destroying operations;
improper management of the persistent period, early persistent activity;
dystocia of the cervix (insufficient dilatation), cervical stiffness;

Signs of uterine rupture

Cervical ruptures are classified by degrees:

1 degree - a gap of no more than 2 cm in length;
Grade 2 - the gap exceeds 2 cm in length, but does not reach the vaginal vault;
Grade 3 - the rupture has moved to the vaginal vault and / or the lower segment of the uterus (lost in depth).

Clinical manifestations, as a rule, are absent with ruptures of the cervix of the 1st degree. Bleeding is a characteristic sign of cervical damage, but it does not always appear. The intensity of bleeding does not depend on the degree of rupture, but on the caliber of the damaged vessel.

It is possible to suspect a rupture of the cervix immediately after the expulsion of the fetus and the discharge of the placenta and bleeding that appears, against the background of a well-contracted uterus. At the same time, the blood is scarlet, it can flow out in a trickle or intense bleeding develops.

Confirmation of the presumptive diagnosis allows examination of the cervix in the mirrors immediately after the completion of labor. In this case, the cervix is captured by fenestrated clamps and "moved".

Treatment

All cervical ruptures are subject to surgical treatment, that is, suturing. The operation is performed without anesthesia. The edges of the cervical tears are grasped with clamps and brought down into the vagina. The first suture is applied, retreating 0.5 cm from the upper edge of the gap. Subsequent sutures are applied with an interval of 1 cm, matching the edges of the wound, approaching the outer cervix.

For suturing cervical ruptures, catgut is used, which dissolves itself after 5-7 days. After manipulation, the neck is treated with an alcoholic solution of iodine.

If a rupture of the third degree is detected, manual control of the uterine cavity is shown to exclude the transition of the rupture from the cervix to the body of the uterus. In the case of a diagnosis of a rupture of the lower segment of the uterus, a laparotomy is performed, during which the degree of damage to the uterus is established and the issue of its removal (amputation or extirpation) or preservation (suturing of the rupture of the uterus) is decided.

Complications and consequences

In some cases, cervical ruptures remain unnoticed (either there was no bleeding, and an inattentive examination of the cervix was carried out after childbirth, or the birth took place outside the walls of a medical institution), which is fraught with the development of the following complications:

bleeding in late postpartum period and the development of hemorrhagic shock;
the formation of a postpartum ulcer, which gives an impetus for the development of diseases of the cervix in the future and its cicatricial deformity;
eversion of the cervix (ectropion) is a prerequisite for the development of cervical cancer;
ascending infection (the occurrence of endometritis, adnexitis, which is fraught with infertility);
cervical incompetence or ischemic-cervical insufficiency (ICI).

ICI in the future can cause miscarriage, late abortion or premature birth.

Scars on the cervix in the next birth also contribute to the development of abnormalities of labor (weakness of labor forces, discoordination), dystocia of the cervix during labor (insufficient dilation), which often leads to caesarean section.

Impact of trauma on labor outcome and fetus

Since ruptures of the cervix often occur in the second stage of labor, their course, as a rule, does not deviate from the physiological one and labor ends safely with the birth of a living fetus.

But in the subsequent period and after the completion of labor, there is a threat of massive bleeding and the development of hemorrhagic shock, which requires immediate assistance (suturing the gap).

Almost every third woman on the planet at least once in her life has heard a diagnosis of cervical erosion from a doctor, the causes of this ailment are extremely diverse. In addition, many doctors consider any red manifestation in the uterus to be erosion. This judgment is often erroneous. Usually, the disease is asymptomatic, due to which not everyone knows about its existence. Erosion of the cervix is a gynecological disease that involves the presence of ulcers in the uterus. The presence of pathology is revealed on examination by a gynecologist. In addition, the replacement of the natural mucous membrane by the cervical columnar epithelium is noted.

Most women mistakenly assume that cervical erosion is a precancerous condition. But this judgment is not supported by the facts. However, if you do not attach importance to pathology for a long time and postpone treatment, the chances of uterine cancer still appear. Erosion is always a benign process. The appearance of malignant components is an extremely rare phenomenon and practically does not occur.

It is worth distinguishing between pseudo-erosion and true erosion. Pseudo-erosion is almost always congenital, and true erosion is acquired. True erosion of the uterus looks like a bright red spot against the background of a healthy mucous membrane. In most cases, the erosion is oozing at first. Further, the release of blood stops and resumes during sexual intercourse. It is worth noting that true erosion can be congenital, but in most cases it is acquired due to infectious or mechanical damage to the uterus.

The causes of the appearance of pathology

The causes of cervical erosion are extremely diverse, and it is often problematic to establish the true cause. In addition, in some cases, it is simply impossible to identify the cause of the appearance of the pathology. The appearance of acquired erosion is influenced by many factors. It is worth considering the main groups of factors that cause the appearance of pathology.

Sexually transmitted infections

Such ailments include the following diseases:

Gonorrhea. This ailment is almost always transmitted only through sexual contact. The causative agent of the disease in this case is the gonococcus bacterium. Remarkably, this bacterium progresses most rapidly in the female body, in the shortest possible time causing a strong inflammatory process in the cervix, after which erosion appears. Gonorrhea is manifested by profuse purulent discharge from the vaginal area, a strong burning sensation during urination.
Urogenital trichomoniasis. The provocateur of the disease is the Trichomonas bacterium. Infection with the disease occurs through sexual contact. Symptoms of the disease are severe redness of the uterus, burning, itching, profuse foamy discharge, severe pain when urinating. The chronic form of this disease contributes to the occurrence of erosion. In this case, pathology can lead to infertility.
Urogenital mycoplasmosis. This infectious disease causes an inflammatory process in the genitals. Mycoplasmosis rarely occurs on its own and often accompanies trichomoniasis or chlamydia. In this case, with the parallel course of several diseases, erosion manifests itself very quickly.
Urogenital chlamydia. In this case, the disease is excited by chlamydial microorganisms. The infection is transmitted, like the rest, through sexual contact. Erosion in this case appears due to the fact that chlamydia multiply inside the uterine mucosa.
Human papillomavirus infection. In this case, the ailment is caused by the human papillomavirus. HPV is one of the main causes of uterine cancer. In this case, if the pathology is caused by the human papillomavirus, it will be a precancerous condition.

In the body of a woman is important body, which is necessary for conceiving and carrying a child. This is the womb. It consists of a body and a neck. All these parts are directly involved in the generic process. On the other side of the uterus are the two tubes and the ovaries. It is here that the cells ripen, which are subsequently fertilized and turn into babies. There are situations when a woman is faced with various problems that are associated with the above-described organ. One of the most serious risks is uterine rupture. It is about the consequences of this pathology that will be discussed further. You will also learn what a ruptured cervix is. Let us describe the degree and form of this phenomenon, as well as talk about the consequences.

Ruptured cervix

During childbirth, this pathology occurs most often. However, there are times when the dissection of the mucous membranes occurs outside of this process. The main reasons for this circumstance are inflammatory processes, tissue diseases, as well as the woman's age. The rupture of the cervix during the birth of a child is most often the result of a woman's misbehavior. It can also happen due to the large body weight and height of the baby.

Types of rupture of the cervical canal

There are three degrees of cervical rupture. They all differ in the area of the affected membrane. Only a physician is able to sensibly assess the complexity of the pathology and the type of rupture.

First degree. In this case, the length of the dissection of the mucous surface is no more than two centimeters.
Second degree. The cervix is torn more severely. In this case, the dissection has a length of more than two centimeters, but its base does not reach the arch.
The last degree (third). The gaps in this case are very wide. The cervix is completely damaged, the dissection goes to the upper fornix of the vagina.

Are there any consequences for pathology

Rupture of the cervix during childbirth has extremely unpleasant consequences. Of course, most women manage to avoid this phenomenon. To do this, you need to obey the doctor during the process. However, a representative of the weaker sex, preparing to become a mother, should know what a rupture of the cervix during childbirth can lead to. The consequences will be described below.

Heavy bleeding

If the mucous membranes of the cervix are damaged, then the pathology can be detected only after the appearance of the child and the expulsion of the placenta. At this time, the doctor examines the vaginal vaults with a mirror and notes the presence of bruises or tissue fragments.

All this time, there is an intense release of blood. With massive injuries, a woman can lose consciousness. Also, if assistance is not provided on time, then there is a possibility of death due to blood loss.

Treatment includes tissue suturing. The procedure is performed under local or general anesthesia. In some cases, a new mother may need a blood or plasma transfusion.

Inflammatory processes

Rupture of the cervix can have consequences in the form of infectious lesions. Since the tissue was sutured, there are open wounds. Postpartum discharge helps cleanse the vagina. From here, remnants of mucus and blood are removed. All this can get into a fresh wound and cause an inflammatory process. In this case, the woman begins to notice pain in the small pelvis, having an unpleasant odor. Also, in some cases, the temperature rises.

Treatment in this case is usually medication and is carried out on an outpatient basis. However, you need to tell your doctor about your symptoms as early as possible. Otherwise, the infection can spread to nearby organs and affect the uterus, fallopian tubes, and ovaries.

Inversion of the cervix

If the gap has not been properly corrected, then the consequences of pathology can be the most unpredictable. So, in the absence of sutures at the base of the cervical canal, cervical inversion occurs. In this case, that part of the mucous membrane, which is normally located inside, goes into the fornix of the vagina. This leads to a chronic inflammatory process.

Treatment in this case is often surgical. Some women prefer to leave things as they are. In this case, miscarriages can become a consequence of the incorrect location of the cervix, premature birth or cervical insufficiency in subsequent pregnancies.

Childbirth after a ruptured cervix is possible. If the treatment was carried out correctly and on time, then the consequences, most likely, will not arise. However, in the absence of correction, the next pregnancy can be complicated.

Often, when carrying a child after a rupture, there is a possibility of isthmic-cervical insufficiency. In this case, it is necessary to suture the cervix to avoid premature birth.
During contractions, the cervical canal may not open completely. This leads to re-dissection of the mucous membranes.

Oncological pathologies

After a ruptured cervix during labor and the absence of treatment, the risk of malignant lesions increases. Most often, the beginning of such a pathology is erosion. Everything happens due to the fact that the inner epithelium comes out and attaches to the fornices of the vagina.

Ruptured uterus

In addition to dissecting the mucous membranes of the cervical canal, a woman may face such a phenomenon as perforation of the genital organ. It should be noted that this pathology is more serious. It can rarely be overlooked. Most often, uterine ruptures are accompanied by severe pain in the lower abdomen. Such sensations are caused by the contraction of the walls of the organ and extensive internal bleeding. Also, a woman's pulse may decrease and arterial pressure, appear All this is a consequence of blood loss.

In medicine, there are three types of divergence of the walls of the uterus: a threatening rupture, which began and completed. It is worth noting that at the very beginning, the symptoms are not as significant as with the complete separation of the membranes of the genital organ.

When does pathology arise and how to eliminate it?

Rupture of the uterus can occur with some manipulation. These include hysteroscopy, laparoscopy, curettage of the genital cavity, setting a spiral, and so on. Rupture of the uterus during pregnancy most often occurs when there is a scar on one of the walls of the organ. Treatment in this case should be carried out immediately. It is performed under general anesthesia, when the patient is immersed in a state of deepest sleep.

Correction always depends on the area of the uterine ruptures. Of course, doctors are making every effort to preserve the genital organ. However, in some cases this cannot be done. If this happens, the surgeon removes the uterus along with the cervical canal and cervix. Rupture of the uterus can cause the most dire consequences. Let's consider them in more detail.

Massive bleeding

Rupture of the uterus is always accompanied by blood loss. With a threatening divergence of the walls, damage to the vessels of the inner membranes occurs. In this case, blood usually does not flow into the patient.However, the patient may note the presence of a pink impurity in the urine and vaginal discharge. Rupture of the uterus during childbirth is always accompanied by contractions. It is this fact that can give a blurred clinical picture.

With the onset or complete divergence of the membranes, increased intra-abdominal bleeding is observed, which is aggravated by the occurrence of contractions. The woman notes severe continuous abdominal pain. In some cases, the area around the navel may turn blue.

This state very dangerous. The consequence of pathology is often that is why it is worth providing medical assistance to a woman as soon as possible. When a break occurs, it is almost never possible to save a child. Only the lucky ones survive after such oxygen starvation. In this case, the pathology can affect the future life of the baby and cause developmental delays or other consequences.

Infertility

The consequences of a ruptured uterus during childbirth can be quite complex. If the pathology is not detected on time, then doctors are forced to remove the genital organ. This will help save the woman's life. After such an operation, the fairer sex is recognized as infertile. She will never be able to bear and give birth to a child again.

It should be noted that this consequence is often accompanied by depression and stress. Women who do not have children or who have died as a result of oxygen deprivation are especially affected.

Adhesion process in the pelvic area

If there is a rupture of the uterus along the scar or outside this area, then bleeding often leads to the formation of adhesions. Everything is explained quite simply. Fluid that has entered the abdominal cavity cannot be completely removed. As a result, it thickens, the thinnest films appear. They glue the organs together. In medicine, such formations are called adhesions.

The appearance of such parts causes constant pain in the lower abdomen, disruption of the functioning of organs. They often lead to infertility and the risk of ectopic pregnancy.

Inflammation

If it does, then the consequence can be inflammation or infection. The hole must always be sutured. After such a manipulation, a branch of the ichor occurs. Pathogens and bacteria can get into the wound. All this leads to the addition of infection.

Treatment of such a consequence is most often based on the use of medication. This includes antimicrobial, antibacterial and immunomodulatory therapy.

Aesthetic and psychological side

The consequence of a ruptured uterus is always the suture of the lower abdomen. In this case, the cut can have a horizontal or vertical position. Such wounds remain for the rest of her life and constantly remind a woman of what happened to her. Many of the fairer sex begin to feel ashamed of their body due to the presence of a large scar on it.

It is also worth mentioning the psychological side. Most women experience stress after such manipulation. The anesthesia used can affect the condition of the skin, hair, nails and impair memory.

Is it possible to give birth after treatment of pathology?

Childbirth after a ruptured uterus is possible only if the woman has retained her reproductive organ. At the same time, most doctors insist on carrying out caesarean section, as they fear the recurrence of complications.

It is worth noting that if there are stitches in the cavity of the genital organ, it is necessary to carefully monitor the course of the next pregnancy. Such women are more often prescribed ultrasound examination and additional manipulations.

If there is a suture on the uterus, then there is a risk of the placenta growing into it. This can only be learned during childbirth. In this case, doctors most often remove the pathological child's place along with the organ. This also happens through a cesarean section.

Can complications be avoided?

Rupture of the uterus and cervix can be prevented. To do this, you need to listen to the advice of specialists and follow all the recommendations during childbirth. Most women find it difficult to control themselves in this process. That is why various complications arise.

Even before pregnancy, it is worth undergoing examinations and, if necessary, treating. It should be noted that the presence of genital infections and inflammatory processes causes risks. Such groups of women have loose mucous membranes affected by microbes.

Summing up and a small conclusion of the article

If you have already had breaks and are planning another pregnancy, then you should definitely visit a gynecologist before that. The doctor will examine you and give you the necessary recommendations.

In some cases, preliminary correction may be required, which will help to exclude complications in the future. Be healthy and do not get sick!

The cervix is the canal that connects the vagina and uterus. It performs an important function, the basis of which is to protect against the penetration of infections into the uterus. This is a kind of "nipple" at the entrance to the uterus: it releases everything and does not admit anything. During the birth process, the cervix acts as a kind of corridor that serves as the exit of the baby from the uterus. This important organ is often susceptible to pathologies and infections. In this article, we will discuss the problem of cervical ruptures of varying degrees.

Collapse

What is a ruptured cervix?

A rupture of the neck is a dissection of the mucous membranes as a result of exposure to an organ. According to statistics, neck discrepancies occur in 50% of all women in labor. Moreover, childbirth is the most common cause of this pathology.

Why does a gap occur during childbirth? Ideally, before starting pushing, the cervix should open 10 cm beforehand. If a woman did not wait for the right moment and decided to push earlier, then she cannot avoid such a phenomenon. Often, in parallel to the rupture of the cervix, a perineal dehiscence is attached, which entails additional problems. This phenomenon is shown graphically below.

Reasons for breaks

Since most often discrepancies of the cervix are observed in women in labor, the causes of this pathology are mostly associated with childbirth. According to obstetricians-gynecologists, ruptures occur if a woman has a narrow pelvis, an early rupture of amniotic fluid has occurred.

The main causes of pathology:

Labor activity occurs rapidly or, on the contrary, very slowly;
Large fruit;
Unskilled obstetric care;
The woman in labor has reduced tissue elasticity due to age or due to frequent abortions;
The fetus is in a breech position;
The woman in labor is over 30 years old;
Second birth after a previous rupture of the cervix;
Cervical tissue is incompletely stretched;
Anomalies that have arisen during labor;
If the patient has scars on organs left over from previous childbirth and manipulations.

If a woman in labor has at least a few of the above reasons, then she is at risk of those who can get a cervical rupture during childbirth.

Another reason for cervical tissue discrepancy during childbirth is the use of forceps or vacuum to extract the fetus. These devices speed up the birth process, but violate the integrity of the cervix.

Symptoms and signs of manifestation

The manifestations of this process depend on the degree and type of rupture. The reason that caused this process also affects the symptomatology. The course of pathology is also affected by the presence of accompanying diseases, the psycho-emotional state of the girl.

Consider the main signs of cervical discrepancy, both during the birth itself and after them.

Bleeding. Cervical trauma is always accompanied by bleeding. It can be both internal and external. Such bleeding is both scanty and profuse. Sometimes blood clots come out. In parallel with bleeding, the following symptoms appear:
Cold clammy sweat;
Weakness;
Pallor of the skin;
Fainting.

If the gap is less than 1 cm, symptoms may not appear.

Uterine defect. If the cervix diverges during childbirth, a rupture of the uterus itself may occur. This is an unwanted complication that can lead to the death of the child. With the divergence of the cervical tissue along with the uterus, the following symptoms are observed:
Excessive activity of a woman;
Frequent attempts;
The contractions became more painful.

From the external signs of rupture, edema of the vagina and vulva is observed. If the divergence of the cervix is complicated by the divergence of the uterus itself, then the woman feels an unexpected sharp pain, burning sensation and her labor is interrupted.

A rupture of the cervix that occurs after the birth process leads to the following symptoms:

Depression;
White skin;
Vomit;
Low blood pressure;
Rapid pulse.

Types by the way of occurrence

This pathology is divided into types according to the method of its formation. This is important, because it is precisely the correct type of break that will help quickly provide assistance. By the type of occurrence, they are divided into two groups.

Spontaneous. These are the breaks that occur during the natural birth process and the reason for them is:
The age of the woman in labor (over 30);
A large number of abortions;
The presence of scars on the neck;
Large fruit;
Unskilled obstetrician care;
Breech presentation;
The narrow pelvis of a woman in labor;
Prolonged labor;
Inelastic neck.
Violent ruptures occur for reasons of outside interference during labor. They consist in mechanical injury to the cervix.
Using forceps to pull out the baby and vacuum;
Removing the child by the pelvic region.

If a woman has several symptoms at the same time, then the risk of rupture is quite high.

Types by type of complication

Another classification of such a pathology of the cervix is sorting by the type of complication. Such breaks are of two types.

Complicated. This group leads to complications not only on the cervix itself, but also on nearby organs. There are several types of severe tears:
The discrepancy of the tissues reaches the vagina and captures its vaults;
The tissues disperse, touching the inside of the vagina;
The rupture goes up to the cervical canal and reaches the opening of the entrance to the uterus;
The tissue discrepancy is so great that it affects the peritoneum and the fatty layer around the uterus.
Uncomplicated tears are classified in grades 1 and 2. Read about the degrees of tissue divergence in the next subheading.

The degree of this pathology of the cervix

Classification by degrees is divided according to the depth and width of tissue divergence. There are three degrees in total.

The first stage is characterized by a rupture on one (possibly on both) sides, which does not exceed 2 cm.
This stage implies a size larger than 2 cm that does not reach the vaginal vault. The deepening of such a discrepancy of the fabric is about 1 cm.

These tears not only reach the fornix of the vagina, but also pass into the vagina.

The first two degrees are characterized as uncomplicated ruptures, and the third entails a number of complications.

Diagnostics

To diagnose this pathology in a woman, the doctor must know well whether the woman is at risk. Information should be collected even before childbirth about whether there were ruptures earlier, in what condition the cervix is (whether there are scars), whether this is the first birth and at what age.

If, during or after childbirth, there is a suspicion of a rupture of the cervix, then you need to follow these steps.

When bleeding, determine its nature.
Palpation of the abdomen to determine its tone, determine the size.
A woman should measure her blood pressure and pulse.
Look for outward signs such as cold sweat and pallor. This will indicate internal bleeding.
The discrepancy of the cervical tissue is visible when viewed on a mirror. In the gynecological chair, the doctor can easily detect pathology.
If there is a suspicion of a third degree of pathology, then the doctor manually examines the surface of the cervix and determines the nature of the complication.

After confirming the diagnosis, treatment should be started immediately.

Treatment

You should start fixing the problem immediately. They begin to eliminate the problem immediately by surgery. The gap is sutured with threads that dissolve. The operation is performed under local anesthesia.

Operation technique:

From the upper corner of the tissue divergence, they begin to sew towards the inner base of the uterus. In the event of a rupture of the uterus itself, a laparotomy is performed and the issue of preserving the integrity of the uterus is resolved.
If the rupture has occurred again, then before it is sewn up, the coarse tissue is removed, which has been healed from the last time.
After that, the mucous membrane is pulled together and carefully sutured, forming a new scar.

The picture shows a schematic of the sewing process.

After the operation, the patient is shown restorative therapy. This therapy includes three groups of drugs:

Hemostatic. There is a risk of anemia if bleeding occurs during ruptures. Therefore, the patient is prescribed the following drugs:
Aminocaproic acid;
Amiocardin;
Etamsilat;
Gemotran.
In order to avoid introducing infection into the wound, the woman will be prescribed antibiotics.
Cefotaxime;
Amoxilav;
Ceftriaxone;
Maisonex.

IMPORTANT! Antibiotics are prescribed by a doctor, weighing the pros and cons of these drugs for a woman who has just given birth and plans to breastfeed.

Topical antiseptics. To disinfect the wound, douching with antiseptics and some anti-inflammatory ointments are prescribed. For example, Horhexidine solution. Again, these procedures should be performed under the close supervision of a doctor.

To avoid complications after treatment, the patient should avoid sexual intercourse for about two months after stitching the gap.

Consequences and complications

There are times when the rupture condition has gone unnoticed. For example, if the woman did not have bleeding and pain syndromes. Or the tissue divergence itself was minimal. However, this kind of phenomenon can lead to consequences:

Bleeding, which opens in the postpartum stage and can lead to the development of hemorrhagic shock;
The development of a postpartum ulcer on the cervix, which can lead to deformation of the cervix and the development of scars on it;
Ectropion (inversion process of the cervix in the vagina), which can lead to the development of oncology;
Inflammation, such as adnexitis, endometritis and, as a result, infertility;
Cervical insufficiency, leading to miscarriage or premature birth;

Scars that remain on the neck will lead to the following deviations:

Weak birth process;
Discoordination;
Small dilatation of the uterus;
The need for a cesarean section.

If you notice the problem in time and follow all the doctor's recommendations, then there will be no consequences.

Prophylaxis

To reduce the likelihood of ruptures, you should listen to your health and prepare ahead of time.

Strengthen intimate muscles before childbirth;
Drink vitamins and eat strictly;
Learn to breathe correctly during the birth process;
Listen carefully to obstetricians.

What can the medical team do?

Inject an antispasmodic;
Do not make rough movements when using a generic instrument;
If there were tissue discrepancies, take this into account during childbirth and be as careful as possible.

So, a rupture of the cervix is serious if the patient did not receive help on time. Otherwise, this diagnosis is perfectly cured.

- violations of the anatomical integrity of the tissues of the cervix or the body of the uterus, caused by the effects of mechanical, chemical, thermal, radiation and other factors. Damage to the uterus is usually accompanied by bleeding, pain in the lower abdomen; the formation of fistulas is possible. In the future, such injuries can lead to miscarriage or infertility. Damage to the uterus is detected by gynecological examination, cervicoscopy, hysteroscopy, ultrasound, diagnostic laparoscopy. Treatment tactics (conservative or operative) depend on the type of damaging factor and the nature of the injury.

General information

Damage to the uterus - various kinds of injuries leading to the formation of anatomical defects and dysfunction of the organ. Most often happen during medical interventions and childbirth, but can occur outside of these events. Uterine injuries in gynecology include bruises, ruptures, perforations, fistulas, radiation, chemical and thermal injuries. Damage to the uterus often requires emergency assistance, since it is accompanied by bleeding, painful shock, infection, and in the future can lead to serious reproductive disorders. Birth injuries are considered in detail by us separately, since they have their own causes and characteristics. With regard to injuries of the internal genitals associated with bruises, intrauterine manipulations, operations or sexual intercourse, they account for approximately 0.5% of all causes of hospitalization in gynecological hospitals.

Causes of damage to the uterus

Uterine bruises are more common in pregnant women; they can be caused by a fall, hit to the abdomen with a blunt object, or a car accident. Abdominal, vesicouterine, ureteral-uterine fistulas can occur due to birth trauma, surgical interventions with secondary wound healing, iatrogenic damage to the bladder or ureters during gynecological operations, the collapse of malignant tumors, radiation exposure, etc.

Thermal and chemical damage to the uterus is rare. Thermal injuries usually occur from douching with too hot solutions. Chemical damage to the uterus can be caused by the use of cauterizing substances (silver nitrate, acetic or nitric acid), as well as the deliberate introduction of chemicals into the uterine cavity for the purpose of criminal abortion.

Types of damage to the uterus

Contusion of the uterus

The risk of such damage to the uterus increases in pregnant women in proportion to the increase in gestational age. Isolated bruises of the uterus can provoke spontaneous abortion at any time, premature placental abruption or premature birth. These complications are usually indicated by bloody discharge from the genital tract, abdominal pain, increased uterine tone. In case of damage to the chorionic villi, fetal-maternal transfusion may develop, in which the blood of the fetus enters the bloodstream of the pregnant woman. This condition is dangerous by the development of fetal anemization, fetal hypoxia, and intrauterine death. In severe blunt trauma to the abdomen, ruptures of the liver, spleen, uterus are also possible, and therefore massive intra-abdominal bleeding develops.

To determine the severity of the injury, the condition of the pregnant woman and the fetus, in addition to traditional physical and laboratory tests, a gynecological examination, ultrasound of the uterus and fetus, CTG are performed. In order to detect blood in the pelvic cavity, culdocentesis or peritoneal lavage is performed.

Treatment of uterine injuries and their consequences is carried out taking into account the severity of the injury and the gestational age. For mild bruises and early dates gestation, dynamic observation with ultrasound control and CTG monitoring can be carried out. At a gestational age close to full-term, the question of early delivery is raised. If blood is found in the abdominal cavity, an emergency laparotomy is performed, bleeding stops and the damaged organs are sutured. Feto-maternal transfusion may require intrauterine blood transfusion.

Ruptured uterus

Minor cervical ruptures may be asymptomatic. With extensive and deep defects, bloody discharge of a bright red color appears: blood can flow out in a trickle or stand out with clots. Cervical ruptures are usually recognized clinically or by examining the cervix in mirrors. With such injuries, catgut sutures are applied to the cervix. If such damage to the uterus was not detected in time or correctly sutured, in the future they can be complicated by the formation of hematoma in the parametrium, cervicitis, postpartum endometritis, ectropion and erosion of the cervix.

Perforation of the uterus

When the uterine wall is perforated with a surgical instrument, intra-abdominal or mixed bleeding develops. At the same time, patients feel a sharp pain in the lower abdomen, complain of bloody discharge, dizziness and weakness. With massive internal bleeding, arterial hypotension, tachycardia, and pallor of the skin are noted. Along with damage to the uterus, injury to the bladder or intestines can occur. The most common complication of uterine perforation is peritonitis.

Perforation of the uterine wall can be recognized even during intrauterine manipulation by characteristic features (feeling of "failure" of the instrument, visualization of intestinal loops, etc.). The diagnosis in this case is confirmed by the data of hysteroscopy, transvaginal ultrasound of the pelvic organs. The main method of treatment of perforating injuries of the uterus is surgical (tear suturing, subtotal or total hysterectomy).

Fistulas of the uterus

Abdominal fistulas connect the uterine cavity with the anterior abdominal wall and are external. The outlet opening of the fistulous tract often opens in the area of the suture or postoperative scar. The presence of a fistula is supported by inflammatory infiltration of the fistulous tract. It is manifested by the periodic release of blood and pus through the cutaneous opening of the fistula. Fistulas are found during examination and hysteroscopy. Treatment - excision of the fistulous passage and suturing of the uterus.

The main signs of a vesicouterine fistula are cyclical menouria (Yussif's symptom), the discharge of urine from the vagina, the symptom of "laying" a stream of urine during the formation of bladder blood clots, secondary amenorrhea. Uretero-uterine fistulas are manifested by leakage of urine from the vagina, back pain, fever caused by hydroureteronephrosis. Genitourinary fistulas are detected during examination of the vagina in the mirrors, cystoscopy, hysterography. Treatment - surgical closure of fistulas (fistuloplasty), plastic ureter.

Uterine-intestinal fistulas can be the result of perforation of the uterus with damage to the intestine, breakthrough into the intestine of an abscess that developed after conservative myomectomy or cesarean section. The course of intestinal-uterine fistulas of inflammatory genesis is recurrent. Before the breakthrough of the abscess into the large intestine, pains in the lower abdomen, hyperthermia, chills, tenesmus increase. Mucus and pus appear in the stool. After emptying the abscess, the patient's condition improves. However, due to the fact that the fistulous opening quickly undergoes obliteration, pus soon again accumulates in the abscess cavity, which causes a new exacerbation of the disease.

For diagnostics, examination of the vagina with the help of mirrors, combined gynecological ultrasound, rectovaginal examination, sigmoidoscopy, fistulography, CT and MRI of the pelvis are used. The tactics for this kind of pathology are only surgical; includes "intestinal" and "gynecological" stages. The details of the intervention are determined by the operating gynecologist and proctologist. Excision of necrotic tissue and restoration of intestinal integrity is usually combined with supravaginal amputation or extirpation of the uterus.

Chemical and thermal damage to the uterus

In the acute period after damage to the uterus of this kind, the clinic of endomyometritis develops. Worried about an increase in body temperature, pain in the lower abdomen, sometimes - bloody discharge caused by the rejection of the necrotically altered uterine mucosa. Such injuries can be complicated by peritonitis and sepsis. After healing of thermal and chemical injuries, cicatricial changes in the cervix, atresia of the cervical canal, and intrauterine synechiae can form. In the long-term period, the development of hypomenstrual syndrome or amenorrhea, infertility is likely.

Diagnostics is based on clarifying the anamnesis (identifying the fact of the introduction of hot solutions or chemicals into the vagina), examination data of the cervix in the mirrors, gynecological ultrasound. Treatment is detoxification and antibacterial therapy. With the development of peritonitis, laparotomy, sanitation and drainage of the abdominal cavity are carried out; with extensive necrotic damage to the uterus - extirpation of the organ. In the future, to restore the patency of the cervical canal, it is bougienated. In Asherman's syndrome, hysteroscopic separation of synechia is shown.