Injury to the uterus symptoms. Damage to the cervix and body of the uterus

The purpose of a woman on Earth is to produce offspring. Childbirth is a natural physiological process invented by nature. Many women know that the birth of a child does not always go smoothly. Complications often occur, accompanied by rupture of the cervix. The health of the expectant mother depends on how quickly the obstetrician-gynecologist notices this and takes action.

Rupture of the cervix in 98% of cases is a consequence of an incorrect course of labor. Distinguish:

  • Independent:
  • Due to the weak stretching of the tissues. It is typical for primiparous women after the age of 29 years. (In the USSR they were put in the risk group of "old-timers");
  • Rapid labor (in primiparous up to 5 hours, in multiparous up to 2 hours);
  • Large child (weighing more than 4 kg);
  • The narrow pelvis of the woman in labor (determined by the gynecologist).
  • Violent, when the doctor conducts surgical measures to accelerate the birth of the fetus (by using forceps, vacuum, or pulling the fetus out by the ass).

From the degree of damage, the gap is classified into 3 degrees:

  • Grade 1 - tear on one side (rarely on two) no more than 1.5 cm. During childbirth, the cervix opens, its edges stretch and become thinner. Full disclosure is achieved with a diameter of 10 - 12 cm. At this moment, the woman in labor feels attempts and the midwife allows her to push. It happens that the expectant mother starts to push early or does it not in a fight, the walls of the uterus can not stand it and are torn.

Cracks up to 0.5 cm are accompanied by weak vaginal discharge, and often they can be overlooked.

  • Grade 2 - from 2 cm or more, but the tear does not extend beyond the edges of the uterus. This happens if a woman with a narrow pelvis gives birth to a very large child in a natural way. The fault lies with the diagnostician who carried out control measurements of the pelvis of the woman in labor and the parameters of the fetus on prenatal ultrasound.

1 and 2 degrees refer to uncomplicated ruptures.

  • Grade 3 - complicated rupture, more than 2 cm, affecting the vaults of the vagina or peritoneum. Accompanied by severe bleeding. A woman in labor is observed: a decrease in blood pressure, pallor of the integument, an increase in pulse, cold sweat.

It is possible to detect tissue deformation and determine its degree only after the birth of the child and afterbirth. Medical staff examines for complications. Timely undetected cracks lead to the development of infection, large blood loss or the formation of rough ones.

Causes

Not always the cause is a violation of the flow of obstetrics. This can be facilitated by the state of the uterus itself before pregnancy or during childbirth:

The presence of one of the listed reasons in a woman in labor does not always lead to pathology. But, it requires some control.

Cervical rupture can occur at any time:

  • Before giving birth

A scar from previous operations in a second pregnancy can provoke a rupture, which will lead to miscarriage or premature birth with complications.

Also, a violation of the integrity of the uterus can be a consequence of an ectopic pregnancy.

To prevent such adverse effects, constant competent supervision of a specialist is required.

  • In childbirth

Tears during childbirth are the result of too much stretching of the cervical tissue. During natural childbirth or surgical exposure, there is pressure on the walls of the cervix and its damage, which in turn leads to deformation. With a deformation of 2.5 cm, the doctor must decide on an emergency. Rapid diagnosis and surgical intervention reduces the risk of consequences.

  • When having sex

Extremely rarely, a violent sex life causes the formation of tears. This occurs during the sexual process using foreign objects. When injured, there is severe pain in the lower abdomen, vaginal bleeding, weakness and dizziness.

Damage up to 6 mm is not always detected immediately. Weak blood discharge is attributed to hormonal changes. At the same time, there is a deterioration in well-being, accompanied by weakness, pallor of the skin and mucous membranes, increased sweating.

With a crack more than 2 cm, there is severe bleeding with clots, burning and pain in the perineum. Nausea occurs, blood pressure decreases, the heart rate changes and pain shock develops. Doctors fix such symptoms immediately, and perform immediate surgery, up to an emergency caesarean section.

Diagnostics

Today, the diagnosis of complications is carried out immediately in the delivery room when examined by an obstetrician-gynecologist. When small blood secretions appear, it is determined at what period of labor this happened, and whether there was an intervention by medical personnel. An internal examination is carried out using gynecological mirrors and the method of palpation of the uterine cavity and abdomen for the presence of muscle tension and large gaps of the 3rd degree. After carrying out all the procedures and making a diagnosis, the gynecologist chooses the treatment. All consequences are eliminated by suturing. With a properly performed operation, the recovery period does not require special conditions and has no complications.

Consequences of a break

Unfortunately, it is not always possible for an obstetrician to identify pathology directly in the delivery room. The consequences can be very serious:

Incorrect suturing provokes the formation of rough scars. This reduces the plasticity of the cervical tissues, causes miscarriages or premature births in subsequent pregnancies, causes erosion and bleeding during intercourse.

Surgery is the main method of treatment.

Lesions up to 0.5 cm usually heal on their own. With a mild degree of trauma, cracks and tears are sutured with self-absorbable threads. Healing is fast and lasts up to 3 weeks. Treatment and use of medicines is not required. Sexual rest lasts up to 3 months.

With complex and deep wounds, an abdominal operation (abdominal surgery) is performed. When the rupture passes from the uterus to the adipose tissue around, with the formation of hematomas. Be sure to prescribe drugs to exclude, the occurrence of erosion and increase the immune system.

Pregnancy after cervical rupture

Pregnancy after cervical rupture is possible. This requires timely prevention (ultrasound, treatment, tests).

Any crack in the neck requires careful observation. When forming a rough seam, they can form in the small pelvis. They will interfere with ovulation and directly the onset of pregnancy. Premature birth or miscarriage can also be due to weak tissues or the presence of a scar.

With proper treatment, specialists minimize these problems. All subsequent births are carried out through a caesarean section so as not to provoke a second rupture of the suture. Childbirth in this case is carried out for a period of 37-38 weeks.

Pregnancy in the cervix, its consequences

Pregnancy in the cervix (med. cervical pregnancy) is a rather dangerous pathology of the development of pregnancy.

Even 20 years ago, the removal of the uterus with this type of childbearing was the only possible method of treatment. This was caused by probable profuse bleeding and, without immediate surgical treatment, led to the death of the pregnant woman.

Nowadays, recent studies and experiments have allowed gynecologists and surgeons to help the patient with the preservation of the reproductive organ.

Treatment is possible only under the strict supervision of a physician. A woman is prescribed special drugs depending on her physiological state.

More than 50% of women after such medical and surgical treatment can become pregnant again and give birth naturally.

The main rule of prevention is the correct course of pregnancy and childbirth, namely:

Rupture of the cervix is ​​an extremely unpleasant pathology of the outcome of childbirth. But, with properly carried out prevention, timely diagnosis and competent surgical intervention, the woman will not cause much trouble.

Happy motherhood!

Video: Sexual life after childbirth with perineal rupture

Video: What to do to give birth without breaks

A woman is a tender and vulnerable creature, both literally and figuratively. But nature has endowed the female genital organs with remarkable strength. The resistance of the uterus, 9 months from day to day, stretched during pregnancy, and in the later stages of gestation, mercilessly kicked by the fetus; unceasing (for many years) work of the ovaries - imagine, in order to release a new egg “into the light”, their fragment breaks, and so on monthly. But the female genitals sometimes do not withstand physical love - during intercourse, their injuries are not so rare.

Classification of injuries of the female genital organs received during sex

Unlike men, according to whose varieties one can write entire treatises, for women such diversity is less inherent (except for wounds) - therefore, the “female” classification is more “primitive”. So, injuries to the female genital organs that can happen during sex are as follows:

Despite the rampant sexual educational program thanks to the open sources of the Internet, the traumatization of the female genitals in the 21st century is far from a rare phenomenon. The main causes of such injuries:

  • sexual illiteracy during intercourse, as a result - the incorrect use of sexual techniques and postures;
  • sexual relations while taking alcohol, drugs or medical psychedelic drugs that disable control over what is happening;
  • blind imitation of book or movie characters;
  • molestation of girls, whose genitals are still too tender and not adapted to "adult love";
  • sexual intercourse with elements of violence - against the will of the partner or using devices for aggressive stimulation of the female genital organs.

Microtrauma (rubbing) of the female genital organs

This is the most common type of trauma to the female genitals during sex.

Microtraumas (rubbing) of the labia majora and labia minora, as well as the clitoris, occur due to the wrong tactics of a man, his haste or frankly sloppy, careless attitude towards a woman during coitus.

The condition is aggravated due to ignoring the rules of personal hygiene - as a result, even not too intense efforts can lead to irritation of the skin and mucous membranes, from which to microtraumas - one step.

Vaginal microtrauma occurs due to an insufficient amount of lubrication, which is normally released as a result of a woman's sexual arousal. Causes of "lubrication deficiency" in a partner:

  • frigidity (sexual coldness);
  • lack of arousal during forced intercourse;
  • disruption of the excretory glands (those that produce lubrication);
  • (it happens due to a violation of the water and electrolyte balance as a result of systemic diseases that may be directly and not related to the female genital area).

A separate case when microtraumas of the vaginal walls appear is vaginismus- spasm of the muscles of the vagina with the presence of a male penis inside it. Vaginismus occurs in women during intercourse due to fear, haste, dissatisfaction with a partner or sexual intercourse, and so on. As a result of such a spasm, the penis is literally trapped. A man in a panic tries to pull out the stuck penis with jerks, thereby injuring (rubbing) the vaginal mucosa.

Microtrauma of the female genital organs can be regarded as the easiest type of trauma during intercourse.But the costs because of them are greater than it seems at first glance:

  • due to the fact that they do not pay attention to micro-wounds, they become chronically irritated and eventually begin to heal poorly, and if they heal, then in the form of scars;
  • constant mechanical irritation of tissues in the same location can cause an unhealthy response of cells - in other words, this is the risk of their oncological degeneration (in particular, in the place of scar tissue).

Symptoms: moderate, aggravated during intercourse.

Clitoral injury

This type of trauma to the female genital organs during sex rarely happens, because the clitoris is quite reliably "hidden" in the tissues. If this happens - The main causes of damage to the clitoris are as follows:

  • rough persistent stimulation (most often with sex toys);
  • "a disservice" of the partner in the form of excessive efforts in order to give pleasure to the partner through cunnilingus (an oral type of sex during which the man takes an active position);
  • constant awkward positioning of partners during intercourse, in which the clitoris feels pressure - in other words, technically illiterate sex.

In its structure, the clitoris is similar to the penis - it also has cavernous (cavernous) bodies, and during the excitation of a woman, this organ, like the penis, overflows with blood and erects. Therefore, if it is injured (for example, with inaccurate stimulation with aggressive sex devices - clamps, and so on), significant bleeding may occur.

Symptoms: point pain, aggravated during urination, redness and swelling of the clitoris and surrounding tissues.

Rupture of the walls of the vagina

It often happens in the classic position with the legs of a woman on the shoulders of a man (the so-called officer's position), when the partner overdoes it with the strength and frequency of frictions (progressive repetitive movements of the penis into the vagina in a "back and forth" type). Also observed with clumsy change of posture.

Normally, the walls of the vagina are quite elastic and, under mechanical action, are well stretched, withstanding the pressure of a rather large force. Aggravating circumstances when the vaginal wall does not withstand and breaks:

  • narrow vagina (congenital, in women with little sexual experience, after surgical suturing);
  • pathological changes in the vaginal wall (atrophic or scar tissue changes);
  • large partner penis with excellent erection;
  • the use of hard traumatic nozzles on the penis in an attempt to enhance sexual sensations.

The lion's share of such damage falls on the back wall of the vagina (due to the popularity of classic missionary positions), much less often on the front wall (with intense sex in the “back partner” position). In women who have given birth, the risk of such a gap during intercourse is less.

Sometimes the frictions can be so strong, and the vaginal wall so weak, that not only it breaks through, but also the surrounding organs.: with perforation of the posterior wall of the vagina, damage to the rectum with penetration into its lumen is possible, with perforation of the anterior wall - damage to the bladder with penetration into the lumen. Perhaps the perforation of the vaginal wall with the loss of intestinal loops into it.

Symptoms: sharp, sometimes unbearable pain in the vagina and, increasing even after the cessation of sexual intercourse, accompanied by bleeding. With a through (complete) breakthrough of the vaginal wall and prolapse of intestinal loops into it, symptoms of peritonitis develop and increase (inflammation of the peritoneum - a membrane that covers the abdominal cavity from the inside): sharp pain on palpation (palpation) of the anterior abdominal wall, dry mouth, fever, impaired intestinal motility, a sharp deterioration in general condition. With a through injury to the rectum and bladder, feces and urine are excreted from the vagina.

Rupture of the vaults of the vagina

Occurs in case of extreme disproportion between the vagina and the penis. The latter literally has nowhere to turn around due to its size, and the penis reaches the vaults of the vagina - its most deeply located arch-like areas that are adjacent to the cervix.

Most often, a gap is observed in the posterior and lateral vaginal fornixes, very rarely in the anterior (for the same reasons as damage to the walls of the vagina).

Symptoms: the same as with a rupture of the walls of the vagina.

Damage to the ligaments of the uterus

The uterus is attached to the surrounding tissues by bundles of connective tissue - ligaments. With strong uncontrolled shocks during frictions, it shifts, the ligaments literally stretch (in advanced cases, almost to the state of “looseness”). This state of affairs is observed if partners are engaged in physical love, the weight categories of which are strikingly different (a large powerful man, a thin thin slender woman).

The danger of damage to the ligaments of the uterus lies in the fact that after a while they cease to perform their holding function. The uterus is displaced from the normal axis, and this is already a threat to the reproductive function (the ability to become pregnant, bear and give birth to a child).

Symptoms: aching pains in the lower abdomen, which can intensify during menstruation (due to contraction of the uterus and thereby disturbing the calmness of its ligaments).

Traumatic bleeding without significant damage to the female genital organs

With a superficial arrangement of blood vessels (in particular, in the walls of the vagina), they can be damaged even if the intensity of sexual intercourse is not too pronounced. In most cases, this is due to the weakness of the vascular wall (for example, with a lack of appropriate vitamins) and is a signal of vascular disease.

Symptoms: bleeding during even non-intense intercourse.

Wounds of various origins

Wounds of the female genitalia of a sex nature are:


Such a variety of wounds to the female genitals during sex, without exaggeration, can compete with their variety during military operations - except that there is no shock wave and radiation damage.

Symptoms: the presence of a wound surface, soreness in its area, bleeding.

Hematomas

Bruises (hematomas) are one of the most frequent and perhaps the most harmless consequences of superficial trauma to the female genital organs during sex. The main reasons for their occurrence are as follows:

  • too intense, close contact during physical love (expressed kisses, pressing, pinching, pinching tissues);
  • weakness of the vascular wall;
  • blood clotting disorders.

Symptoms: characteristic cyanosis of tissues with relatively clear boundaries, swelling, moderate pain.

Diagnosis of injuries of the female genitals received during sex

Injuries to the female genital organs received during sex are not difficult to diagnose. If a couple shows up for an appointment, they are usually ready to share the traumatic details of the sexual intercourse during which the partner was injured. Mandatory examination of a woman on a gynecological chair - in the mirrors and finger. In some cases, to clarify the diagnosis, additional examination methods will be required - a digital examination of the rectum, cystoscopy and rectoscopy.

Treatment

The lightest of injuries (rubbing and bruising) can go away on their own without medical intervention - one has only to eliminate the traumatic factor, and in general a healthy body will recover without outside help. For several days, you should refrain from sex (the duration of the rest regimen depends on the intensity of the damage). Then sexual activity can be resumed, taking into account previous mistakes during physical love.

In the presence of severe bleeding, its source is determined and eliminated (using tamponade or vascular suture). Ruptures of the walls and vaults of the vagina, walls of the rectum and bladder require suturing in the operating room. With weakness of the ligaments of the uterus, reconstructive operations are performed. With symptoms, a laparotomy is performed with sanitation (cleansing) of the abdominal cavity and suturing of damaged organs.

Conservative therapy is used according to indications:

  • in the presence of wound surfaces -;
  • with dryness of the vagina - intimate lubricants;
  • with bleeding without tissue damage - hemostatic drugs;
  • with fragility of the walls of blood vessels, which provokes bleeding - vasoconstrictive drugs (in particular, vitamin complexes).

Prevention of injury during physical love

The advice is rather not medical, but vital: without a sober assessment of your own capabilities, do not try to repeat the tricks from the movie "50 Shades of Gray" and the like.

If you already have a desire to experiment - do it gradually and moderately, remembering that physical health is much more important than momentary sexual pleasure. Be ready to stop at any moment, even on a fantastic take-off of sensations. No orgasms and vivid sensations are worth a woman's disability. And even if a partner is ready to please her partner at the cost of her own suffering and, worse, health, a real man will never allow this.

During delivery, injuries often occur, the main of which are ruptures of the cervix. They can occur through the fault of a woman in labor, a doctor, with improper management of childbirth. A woman should study in advance the main causes of ruptures, possible complications and follow preventive measures so that the child is born without unpleasant consequences.

What are cervical ruptures, why do they appear during childbirth?

The cervix is ​​a canal, one part of which opens into the uterine cavity, and the other into the vagina. During pregnancy, the cervix is ​​closed to protect the fetus from external factors. With the onset of contractions, it gradually opens, starting from the uterus, where the baby's head presses. At the first birth, the process is rather slow, which often requires stimulation.

Until the canal opens completely, you can not push. This will lead to excessive pressure on the walls and damage to them. The woman in labor needs to listen to the advice of the obstetrician, who makes decisions depending on the speed of cervical opening.


Rupture of the cervix is ​​a violation of its integrity. The causes of ruptures can be arbitrary and involuntary. The main reasons why gaps occur during childbirth are:

  • incomplete treatment of inflammatory processes and infections of the genital tract;
  • decrease in tissue elasticity;
  • the presence of scars from previous ruptures or operations;
  • placenta previa in the lower segment of the uterus, due to which the tissues of the cervix soften.

Usually ruptures are observed in primiparas, especially if they are over 30 years old. There are fewer elastic fibers in their tissues, and the genital tract cannot stretch well. The following phenomena during childbirth can lead to injury:

  • the cervix is ​​not sufficiently opened, and childbirth occurs rapidly;
  • sluggish childbirth;
  • stimulation with an unopened cervix;
  • squeezing the tissues between the baby's head and bones (mainly with a narrow pelvis);
  • premature rupture of amniotic fluid;
  • the fruit is large;
  • incorrect positioning of the child, extraction by the legs.


Often the doctor is forced to use mechanical methods to complete the process, such as using forceps, a vacuum extractor, etc. This usually leads to ruptures.


Degrees of ruptures and accompanying symptoms

The rupture can occur on one or both sides of the cervix. There are cases of complete separation of the canal from the uterus. According to the size and nature of the rupture of the cervix, there are 3 degrees of it:

  • 1st: small cracks on one side. When the canal is stretched, the walls become thinner, which causes tears up to 1–1.5 cm. This usually happens if a woman pushes during labor before the onset of the straining period. The symptomatology is expressed by small bleeding. Over time, it can become more intense with the appearance of cramping pain in the lower abdomen.
  • 2nd: damage up to 2 cm. They occur when the size of the fetus does not match the volume of the pelvis. Possible when choosing the wrong method of delivery due to erroneously calculated parameters of the child according to the results of ultrasound.
  • 3rd: obstetric rupture (forced). The channel is torn along the entire length. Damage affects not only the cervix, but also the vagina. Blood discharge is copious, with clots. Accompanying symptoms - blanching of the skin, increased heart rate, lowering blood pressure, cold sweat.


Types of cervical ruptures can be seen in the photo. Treatment tactics depend on the degree of damage. The obstetrician examines and diagnoses ruptures after the completion of childbirth and the release of the placenta. Unnoticed deformations threaten with infections, scars and other unpleasant consequences. The most difficult to identify small lesions (up to 1 cm), which may not even bleed.

Diagnostic methods

Diagnosis takes place directly in the delivery room immediately after the birth of the newborn. During the examination, mirrors are used and the uterine cavity and abdomen are palpated. When bleeding is detected, the time of their appearance is determined. Based on the diagnosis, treatment is prescribed.

Features of the treatment of cervical ruptures

Neck tears are usually repaired with surgery. With properly performed medical manipulations, recovery occurs quickly and without complications.

Ruptures occur mainly in the second stage of the birth process. After the birth of the baby, bleeding stops and assistance occurs immediately. Otherwise, severe blood loss and hemorrhagic shock are possible.

Treatment depends on the severity of the injury. Cracks up to 5 mm and superficial lesions often heal on their own and do not require suturing. Tears of the 1st and 2nd degree are sutured with special self-absorbable threads. Healing lasts up to 3 weeks. Additional medical treatment is not prescribed. Mandatory renunciation of sexual activity for 2-3 months.

With deep wounds, accompanied by ruptures of adipose tissue, abdominal surgery is performed. With heavy bleeding, it is important to stop it as soon as possible. If blood renewal is required, the introduction of blood substitutes or transfusion is indicated. The complex of treatment includes drugs to prevent inflammation and increase immunity.

External seams heal for several weeks. Caring for them involves lubrication with peroxide and brilliant green. In the maternity hospital, this is done by a nurse, and after discharge, by the woman herself. You also need to follow the general recommendations:

  • wear cotton loose underwear;
  • periodically take air baths, lying on a bed without linen;
  • wash after each visit to the toilet, use soap twice a day;
  • wash the outer seam carefully, do not rub, do not wipe (it is allowed to dip with a towel);
  • prevent overcrowding of the bladder, which puts pressure on the uterus and prevents it from contracting.


Consequences of ruptures and possible complications in case of untimely therapy

Timely diagnosed and cured ruptures do not have a detrimental effect on the internal processes of the body. Undertreated pathology threatens with the occurrence of erosion and inflammation, which can lead to cancer or complications of the next birth. In particular, it can provoke a miscarriage or premature birth. Other unfortunate consequences are also possible. They depend on the degree of cervical damage and the quality of care provided:

  • suppuration that provokes the occurrence of endometritis, sepsis, which may require complete removal of the uterus;
  • the appearance of ulcers;
  • eversion of the cervix due to arbitrary scarring (without suturing);
  • neoplasia.

If the rupture of the canal is accompanied by damage to the perineum, the following consequences arise:

  • hematomas, edema;
  • disorders of the urinary system, rectum;
  • loss of sensation;
  • scar formation in the perineum;
  • divergence of seams.


Prevention of ruptures during childbirth

To avoid unpleasant consequences, you must not lose your temper and obey the obstetrician. You can not push if there was no command. In most cases, a gap occurs when medical recommendations are not followed. Since the occurrence of complications during childbirth also depends on the condition of the woman, you should first prepare:

  • timely register for pregnancy;
  • undergo all prescribed examinations, take tests;
  • take vitamins and sedatives, if prescribed by a doctor;
  • exclude heavy physical exertion;
  • Healthy food;
  • fully rest;
  • do perineal massage;
  • exercise muscles (relaxation, contraction);
  • take childbirth preparation courses.

Be sure to attend breathing exercises. Proper breathing at each stage reduces pain and helps to focus on the birth process.

Doctors prescribe antispasmodics or painkillers for prevention. When using tools or removing the child by the legs, injuries occur in most cases. Their degree depends on the accuracy and professionalism of the obstetrician.

If a woman in labor has already had gaps in previous births, erosion or other disorders in the genital tract, the risk of a gap increases. In some cases, in order not to provoke it, a caesarean section is prescribed.

Not the last factor in planning pregnancy and preparing for childbirth is the emotional state of a woman. It is important not to be nervous, tune in to the best, avoid negative thoughts and focus on preparing for the process of childbearing.

- violations of the anatomical integrity of the tissues of the cervix or body of the uterus, due to the influence of mechanical, chemical, thermal, radiation and other factors. Damage to the uterus is usually accompanied by bleeding, pain in the lower abdomen; possible formation of fistulas. In the future, such injuries can lead to miscarriage or infertility. Damage to the uterus is detected using a gynecological examination, cervicoscopy, hysteroscopy, ultrasound, diagnostic laparoscopy. The tactics of treatment (conservative or surgical) depends 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. They are more common during medical interventions and childbirth, but can also occur outside of these events. Uterine injuries in gynecology include bruises, ruptures, perforations, fistulas, radiation, chemical and thermal injuries. Injuries to the uterus often require emergency care, as they are accompanied by bleeding, pain 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 genitalia 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, a blow to the abdomen with a blunt object, or a car accident. Abdominal-uterine, vesico-uterine, uretero-uterine fistulas can occur due to birth injuries, surgical interventions with secondary wound healing, iatrogenic damage to the bladder or ureters during gynecological operations, the decay of malignant tumors, radiation exposure, etc.

Thermal and chemical damage to the uterus are rare. Thermal injuries usually occur in connection with douching with too hot solutions. Chemical damage to the uterus can be caused by the use of caustic agents (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 uterine bruises can provoke spontaneous abortion at any time, premature detachment of the placenta 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, feto-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 anemia, fetal hypoxia, as well as intrauterine death. With severe blunt trauma to the abdomen, ruptures of the liver, spleen, and uterus are also possible, in connection with which 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 studies, a gynecological examination, ultrasound of the uterus and fetus, CTG is 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. With mild bruises and early gestation, dynamic monitoring with ultrasound control and CTG monitoring can be carried out. At terms of pregnancy 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 is stopped and the damaged organs are sutured. Feto-maternal transfusion may require intrauterine blood transfusion.

Uterine ruptures

Minor cervical tears 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 tears are usually recognized clinically or when examining the cervix in the mirrors. With such injuries, catgut sutures are applied to the cervix. If such damage to the uterus was not detected in a timely manner or properly sutured, in the future they may be complicated by the formation of a hematoma in the parametrium, cervicitis, postpartum endometritis, ectropion and cervical erosion.

Perforation of the uterus

When the uterine wall is perforated with a surgical instrument, intra-abdominal or mixed bleeding develops. Patients at the same time feel a sharp pain in the lower abdomen, complain of spotting, 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 signs (feeling of the “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 penetrating injuries of the uterus is surgical (suturing the gap, subtotal or total hysterectomy).

Fistulas of the uterus

Abdouterine fistulas connect the uterine cavity with the anterior abdominal wall and are external. The outlet 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 skin opening of the fistula. Fistulas are detected during examination and hysteroscopy. Treatment - excision of the fistulous tract and suturing of the uterus.

The main signs of a vesicouterine fistula are cyclic menouria (Yussif's symptom), urine output from the vagina, a symptom of "laying" a stream of urine when blood clots form in the bladder, secondary amenorrhea. Uretero-uterine fistulas are manifested by leakage of urine from the vagina, back pain, fever due to hydroureteronephrosis. Urogenital fistulas are detected during examination of the vagina in the mirrors, cystoscopy, hysterography. Treatment - surgical closure of fistulas (fistuloplasty), ureteroplasty.

Uterointestinal fistulas may be the result of perforation of the uterus with damage to the intestine, a breakthrough into the intestine of an abscess that developed after a conservative myomectomy or caesarean section. The course of intestinal-uterine fistulas of inflammatory origin is recurrent. Before the breakthrough of the abscess into the large intestine, pain 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 is quickly obliterated, pus soon accumulates again in the abscess cavity, which causes a new exacerbation of the disease.

For diagnosis, examination of the vagina with the help of mirrors, combined gynecological ultrasound, rectovaginal examination, sigmoidoscopy, fistulography, CT and MRI of the small pelvis are used. Tactics for this kind of pathology is only surgical; includes "intestinal" and "gynecological" stages. The details of the intervention are determined by the operating gynecologist and proctologist. Excision of necrotic tissues and restoration of the integrity of the intestine 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, a clinic of endomyometritis develops. Worried about the increase in body temperature, pain in the lower abdomen, sometimes - spotting caused by 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, intrauterine synechia can form. In the remote period, the development of hypomenstrual syndrome or amenorrhea, infertility is likely.

Diagnosis is based on clarification of the anamnesis (detection of the fact of the introduction of hot solutions or chemicals into the vagina), examination of the cervix in the mirrors, gynecological ultrasound. Treatment - detoxification and antibiotic 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, its bougienage is performed. In Asherman's syndrome, hysteroscopic separation of synechiae is indicated.

Cervical rupture during childbirth: causes and consequences

Cervical rupture is one of the complications of childbirth. A woman may not feel pain if the damage is not too significant, but this does not mean that this situation is unworthy of attention. Immediately after the birth of the child, the doctor conducts a gynecological examination, and if there are gaps during childbirth, they are sewn up.

If you do not carefully suture, this threatens with a number of problems in the future:

  • ectropion (ectropion of the mucous membrane of the cervix), which will be a constant source of inflammation, bleed when touched, including during intercourse;
  • there will be a threat of tissue tear during subsequent births, in principle, such a possibility already exists with a serious degree of cervical rupture;
  • isthmic-cervical insufficiency - a severely damaged neck will not be able to remain closed until the end of the child's gestation period, there will be a threat of spontaneous miscarriage in the later stages and premature birth.

Such complications of cervical rupture during childbirth are very common. To bear a child, women are stitched, the neck is sewn up, as it begins to smooth and open ahead of time. True, this does not always help ... But one way or another, childbirth after a rupture of the cervix can and should be natural if there are no indications for a caesarean section. And the stitches are removed at about 37-38 weeks. Or earlier, if contractions have begun, or amniotic fluid has departed.

The causes of cervical tears during childbirth are different, sometimes they can be prevented, and sometimes not. Sometimes this may be due to unprofessional actions of doctors and midwives. So, often doctors try to manually "open" the cervix to the desired 10 centimeters and injure the tissues.

Other reasons:

  • cervicitis, colpitis are infectious processes;
  • damage to the cervix, scars resulting from abortions, diagnostic procedures, treatment of erosion and dysplasia, especially in the case of conization and diathermoelectrocoagulation - “cauterization” of erosion with electric current;
  • narrow pelvis of the mother;
  • a large fetus, because of this, ruptures of the perineum during childbirth also occur;
  • fast, rapid labor, especially if the baby comes out in the wrong position;
  • rigidity (inelasticity, poor extensibility) of the neck - it happens in both young girls and mature women;
  • early attempts, the woman begins to push, when the preparation of the cervix for childbirth has not been completed, there is no necessary disclosure;
  • the use of obstetric, bullet forceps, vacuum extraction of the fetus and similar manipulations;
  • fetal hydrocephalus.

As you can see, childbirth without ruptures is not always possible. But a woman can still do something to reduce the risk of pathological childbirth. This is to pay attention to vaginal discharge - after all, they are the main symptom of the inflammatory process, which can become one of the provocateurs of ruptures. Naturally, regular supervision at the gynecologist is obligatory. And even better - a visit to a school for young mothers, where they will talk about cervical ruptures during childbirth and how to prevent them. It is necessary to learn in advance the correct breathing, which will help to restrain untimely attempts. To quickly learn this, already being in fights, rarely does anyone succeed.

If a woman had complicated ruptures of the cervix, that is, passing to the walls of the vagina, which have a large area, a thorough examination by a gynecologist should be carried out before a new pregnancy. Often in such cases, you first need to make a surgical correction, this is such a treatment for cervical rupture, and only then, after a while, plan conception. In this case, colposcopy should be normal. It would be useful to do an ultrasound, on which the doctor can examine the scars and suggest the likelihood of problems during pregnancy.

Almost always, ruptures of the cervix during childbirth have consequences of one kind or another. But you don't need to get upset. The main thing is to follow all the instructions of the attending physician. And give birth to a trusted specialist.

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