Traditional medicine

Ruptures after home birth. Ruptures during childbirth - treatment and prevention

The postpartum period for a woman is not always “cloudless”. To daily worries about little man other troubles are added. It all depends on the course of labor. Lately, few people have been surprised by incisions during childbirth. The result of these “procedures” are stitches, which raise many questions among new mothers. Particularly “unpredictable” and “mysterious” are internal seams. This is understandable, because the outer seam can always be touched or even seen, but the inner seams are covered in “darkness”.

How did they appear?

Let's first remember what internal seams are and where they come from. Cause of internal sutures - or vaginal walls. Most often, the tissue of the cervix “tears” when the cervix opens slowly and the woman begins to push prematurely, that is, push out the fetus. Almost every woman experiences premature labor, but they need to be “held back” in every possible way until the cervix is fully dilated. When pushing, the fetal head puts strong pressure on the cervix, and if it has not yet fully opened, it simply ruptures. For the same reason, the walls of the vagina may rupture.

Internal breaks are not always noticeable. However, after childbirth, each doctor carefully examines the woman in labor and provides her with the necessary assistance for ruptures, that is, applies stitches. This procedure is absolutely painless, because the cervix does not have pain receptors, so the woman is not given anesthesia. Sutures are performed in several ways, depending on the severity of the rupture, using special self-absorbable threads. Catgood is mainly used for this - suture material, which is made from the intestines of cattle or sheep - or vicryl.

What to do with them

Absolutely nothing. The only “pleasant” thing about internal seams is that they do not require special care, and do not need any ointments, douching, much less tablets. Since ruptures are sutured with self-absorbing sutures, there is no need to remove them. Over time, they “self-destruct.” When will this happen and how can you find out about it? It all depends on the suture material and the severity of the tear. Usually the threads dissolve completely after 90 days. But there are also those that “disappear” much earlier, but not before the damaged tissues have completely fused. Sometimes “remnants” of thread are noticeable on linen, but this is not the main indicator. Doctors say that there is no need to worry if you do not detect parts of the thread, but do not feel any other discomfort at all.

The main condition for quick and safe healing of internal stitches is personal hygiene. This includes both the cleanliness of the external genital organs and the entire body. Don't forget about your diet too. After all, constipation is extremely undesirable: unnecessary “pushing” adversely affects the condition of wounds that should “grow together.” A woman must also comply with the following requirements:

Do not lift heavy objects;
Do not make sudden movements, especially in the first days after childbirth;
Abstain from sexual intercourse for 1-2 months.

When to see a doctor

Many women complain of abdominal discomfort after internal sutures. Very often there is pain, a feeling of twitching and pulsation. In the first 2-3 days after birth, these phenomena are very normal, but if they continue, then you need to urgently consult a doctor. You also need to see a specialist immediately if you have:

Pain in the area of the sutures does not stop;
There is a feeling of heaviness in the uterus or vagina;
Body temperature rises;
Appear purulent discharge With unpleasant smell.

All these symptoms may indicate either suture ruptures or inflammatory processes in the area of internal seams. In any case, the diagnosis, and even more so the treatment, must be prescribed by a doctor. You may be given either ice, ointments or antibiotics, or a repeat surgical procedure.

However, even if absolutely nothing bothers you in the postpartum period, you should not postpone a visit to the gynecologist. The doctor must “assess” the condition of the scars. If the tissues do not heal properly or the sutures rupture, most often the cervix becomes deformed, resulting in chronic inflammation of the cervix and other sores.

Comes after 3-6 months.

Patience and health to you!

Especially for- Tanya Kivezhdiy

How long does it take to heal
How to care for seams
What complications may there be?
How to film

During childbirth, it is not uncommon for a woman to experience a rupture of the vagina, uterus or perineum. This situation is not difficult, because doctors skillfully and quickly sew up such tears, without paying special attention to it.

In fact, all this is very unpleasant. First, the sewing process is quite painful procedure. Secondly, stitches after childbirth can cause a lot of worries and troubles for a young mother. You need to know how to minimize them and reduce the undesirable consequences of breaks to nothing. Correct postpartum care behind these "battle" scars will largely depend on where they are located.

Species

Depending on where exactly the rupture occurred, there are external (on the perineum) and internal sutures after childbirth (on the cervix, in the vagina). They are made with threads from different materials, which means they require special care, which the young mother must be informed about.

Stitches on the cervix

reason: large fruit;
anesthesia: not performed, since the cervix loses sensitivity for some time after childbirth;
suture materials: catgut, which allows you to apply self-absorbing sutures, which then do not have to be removed; as well as vicryl, caproag, PHA;
advantages: do not cause inconvenience, are not felt, do not cause complications;
care: not required.

Stitches in the vagina

cause: birth injuries, vaginal ruptures of varying depths;
anesthesia: local anesthesia using novocaine or lidocaine;
suture material: catgut;
disadvantages: pain persists for several days;
care: not required.

Stitches on the crotch

reasons: natural (damage to the perineum during childbirth), artificial (dissection by a gynecologist);
types: I degree (the wound concerns only the skin), II degree (the skin and muscle fibers), III degree (the rupture reaches the walls of the rectum);
anesthesia: local anesthesia with lidocaine;
suture materials: catgut (for I degree), non-absorbable threads - silk or nylon (for II, III degrees);
disadvantages: pain persists for a long time;
care: rest, hygiene, regular treatment with antiseptic solutions.

A particular problem is caused by external sutures after childbirth, which are performed on the perineum. They can cause various kinds of complications (suppuration, inflammation, infection, etc.), and therefore require special, regular care. The young mother should be warned about this in the maternity hospital, and also informed about how to treat such wound surfaces. Usually women have many questions about this, and each of them is very important for her health and condition.

How long does it take for stitches to heal after childbirth?

Every woman who has been unable to avoid ruptures is concerned about how long it takes for the stitches to heal after childbirth, because she really wants to quickly get rid of the pain and return to her previous lifestyle. The speed of healing depends on many factors:

when using self-absorbing threads, healing occurs within 2 weeks, the scars themselves resolve in about a month and do not cause much trouble;
Much more problematic is the question of how long it takes for sutures to heal when using other materials: they are removed only 5-6 days after birth, their healing takes from 2 to 4 weeks, depending on the individual characteristics body and care for them;
The healing time of postpartum scars may increase when microbes enter the wounds, so the ability to treat wound surfaces and monitor their cleanliness is required.

In an effort to quickly return to their previous lifestyle and get rid of painful sensations, young mothers are looking for ways to quickly heal stitches after childbirth, so that they do not interfere with them enjoying the joy of communicating with their newborn. This will directly depend on how careful the woman is and whether she competently cares for her postpartum “combat” wounds.

How to care for seams?

If ruptures cannot be avoided, you need to find out in advance how to care for sutures after childbirth in order to avoid complications and speed up their healing. The doctor must give detailed consultation and tell you how to do it correctly. This is part of his professional duties, so don't hesitate to ask. Typically, caring for sutures after childbirth involves a sedentary lifestyle, compliance with hygiene rules and treatment with various wound-healing and antiseptic agents.

In the maternity hospital, the midwife treats external scars with “green paint” or a concentrated solution of “potassium permanganate” 2 times a day.
Change your pad every two hours after giving birth.
Use only loose natural (preferably cotton) underwear or special disposable panties.
You should not wear shapewear that puts strong pressure on the perineum, which has a bad effect on blood circulation: in this case, the healing of sutures after childbirth may be delayed.
Wash yourself every two hours, and after each visit to the toilet.
Go to the toilet at such intervals that a full bladder does not interfere with uterine contractions.
In the morning and evening, when you take a shower, wash your perineum with soap, and during the day simply wash it with water.
You need to wash the outer scar as thoroughly as possible: direct a stream of water directly at it.
After washing, dry the perineum with blotting movements of the towel in one direction - from front to back.
Another important question is how long you can’t sit with stitches after childbirth if they are made on the perineum. Doctors, depending on the degree of damage, call the period from 7 to 14 days. In this case, you are allowed to sit on the toilet immediately on the first day. After a week, you can squat on the buttock opposite the side where the damage was recorded. It is recommended to sit only on a hard surface. This issue needs to be thought through when the young mother returns home from the maternity hospital. It is better for her to lie down or half sit in the back seat of the car.
There's no need to be afraid severe pain and because of this, skip bowel movements. This creates additional stress on the muscles of the perineum, resulting in increased pain. To make this process easier, you can safely use glycerin suppositories after childbirth with stitches: they are rectal and soften the stool without harming the wounded perineum.
Avoid constipation and do not eat foods that have a constipating effect. Before eating, drink a tablespoon of vegetable oil to normalize your stool and not slow down the healing process.
You cannot lift weights weighing more than 3 kg.

These are the basic rules of hygiene, which allow the young mother’s body to quickly recover and return to normal even with ruptures. But what to do if the stitches hurt for too long after childbirth, when all the deadlines have already passed, but it still doesn’t get any easier? Perhaps some factors provoked complications that will require not only additional care, but also treatment.

What complications can occur when suturing?

Very often, a woman continues to feel pain and discomfort even after two weeks after giving birth. This is a signal that something has interfered with healing, and this is fraught with various complications - in this case, medical intervention, treatment, and treatment of sutures after childbirth with special preparations will be required. Therefore, a young mother should be extremely attentive and sensitively listen to her own feelings, and monitor the healing process of postpartum injuries very carefully.

if the scars do not heal for a very long time, they hurt, but upon medical examination there are no pathologies and special problems has not been identified, the doctor may recommend warming up;
they are carried out no earlier than 2 weeks after birth to allow the uterus to contract (read more about restoration of the uterus after childbirth);
For this procedure, “blue”, quartz or infrared lamps are used;
heating is carried out for 5-10 minutes from a distance of 50 cm;
it can be done independently at home after consulting a doctor;
Kontraktubex suture healing ointment can also relieve pain: applied 2 times a day for 2-3 weeks.

The seam has come apart:

if after childbirth the seam came apart, it is strictly forbidden to do anything at home;
in this case, you need to call a doctor or an ambulance;
if suture dehiscence was actually diagnosed after childbirth, most often they are reapplied;
but if the wound has already healed, this will not require any medical intervention;
in such cases, after examination, the doctor will prescribe how to treat the sutures after childbirth: usually wound-healing ointments or suppositories.

very often women complain that their sutures itch after childbirth, and very much so - as a rule, this does not indicate any abnormalities or pathologies;
itching is most often a symptom of healing, so it should not cause anxiety in a woman;
in order to somehow alleviate this unpleasant, albeit favorable symptom, it is recommended to wash yourself more often with water at room temperature (the main thing is not hot);
This also applies to those cases when the seam is pulled: this is how they heal; but in this case, check yourself to see if you started sitting down too early and if you have to carry weights.

If a woman notices unpleasant, abnormal discharge (not to be confused with the return of menstruation), smells bad and has a suspicious brownish-green color, this may mean suppuration, which is serious danger for health;
if the suture festers, you should definitely tell your doctor about it;
This is how complications such as inflammation of the sutures after childbirth or their divergence can occur - both cases require medical intervention;
if infection occurs, antibiotics may be prescribed;
from external processing It is recommended to smear with Malavit shvygel, Levomekol, Solcoseryl, Vishnevsky ointments;
if the scars fester, only a doctor can prescribe what can be used to treat them: in addition to the above-mentioned anti-inflammatory and wound-healing gels and ointments, chlorhexidine and hydrogen peroxide are also used, which disinfect wound cavities.

if after childbirth there is sutureitis, most likely, the basic rule was violated - do not sit during the first weeks: the tissues are stretched and the wound surfaces are exposed;
in this case, it is not recommended to treat the problem area yourself with something, but to contact a specialist directly;
alterations may be required;
but most often it is enough to use wound-healing ointments and gels (Solcoseryl, for example).

If the first days pass without complications and special difficulties described above, there remains one more procedure - removal of sutures after childbirth, which is performed by a specialist on an outpatient basis. You also need to mentally prepare for it so as not to panic or be afraid.

How are stitches removed?

Before discharge, the doctor usually warns on what day the sutures are removed after childbirth: in the normal course of the healing process, this occurs 5-6 days after their application. If a woman’s stay in the maternity hospital is prolonged, and she is still in the hospital at that moment, this procedure will be performed on her there. If the discharge occurred earlier, you will have to come again.

And yet, the main question that concerns all women undergoing this procedure is whether it hurts to remove stitches after childbirth and whether any anesthesia is used. Of course, the doctor always reassures that this procedure It just reminds me of a mosquito bite. However, everything will depend on the woman’s pain threshold, which is different for everyone. If there were no complications, there will actually be no pain: only an unusual tingling mixed with a burning sensation is felt. Accordingly, anesthesia is not required.

Childbirth is an unpredictable process, so anything can happen. However, ruptures are not uncommon and are not perceived by doctors as a complication or difficulty. Modern medicine involves professional, competent suturing after childbirth, which subsequently causes a minimum of discomfort with proper care.

» During childbirth

Stitches after childbirth

At the time of childbirth, situations often arise when ruptures of the perineum or internal organs occur, associated with the peculiarities of their structure or the size of the fetus. During natural childbirth or caesarean section, self-absorbing sutures are used. This is very convenient because they eliminate the further procedure of removing sutures, which is quite problematic given the area where they are applied.

Any woman in labor is interested in the question of how long it takes for sutures to dissolve after childbirth? The answer directly depends on the type of material used for the threads. If this is catgut - material plant origin, then resorption occurs quite quickly, taking no more than 15 days; if synthetic threads such as vicryl are used, then the process takes longer - about 80 days. Self-absorbing sutures after childbirth are selected depending on the location of the tear or incision. For example, for perineal ruptures, threads are applied that take a longer time to dissolve, since ruptures in this area take a long time to heal. For caesarean section or labia tears, catgut is more often used.

Healing of sutures after childbirth, when the perineum ruptures, occurs quite quickly, but may be accompanied by some problems. In order for the wound to heal successfully, constant hygiene, asepsis and rest are necessary. After visiting the toilet, you need to wash the seam with a weak solution of magnesium permanganate and dry it with light tangential movements with a special napkin. These measures must be carried out within a month after suturing. It is also worth abstaining from high-calorie and fatty foods, replacing them with lighter ones that weaken the intestines, since the integrity of the sutures may depend on pushing during stool. In addition, women are not recommended to sit down in the first few days after childbirth. Regular treatment with antiseptic solutions, constant change of sanitary pads and, if necessary, application of sterile dressings completely determine how long the sutures take to heal after childbirth.

Self-absorbing sutures on the uterus and abdominal wall, applied after a caesarean section, are quite painful and therefore require painkillers. The seams on the skin also need to be constantly treated and any stress should be avoided. They will dissolve as the skin's integrity is restored. Internal sutures take longer to heal, from 30 days to 5 months. Resorption of aponeurotic and tendon sutures takes the longest time, since these tissues themselves take a long time to grow together.

When discharged home, doctors give each woman recommendations, in particular how and with what to treat sutures after childbirth, taking into account their condition and location. By following all the obstetrician's instructions, the risk of infection is minimized.

There is a recommendation from obstetricians, which many women in labor “forget” - if a woman has stitches after childbirth, then she should not sit for about 1.5-2 months. You can only lie down or stand. IN as a last resort, for example, when you need to get somewhere by car, a “half-sitting” position is allowed. And no lifting more than the weight of your own baby, under any circumstances.

If the suture hurts after childbirth for a long time, you need to see your doctor, this indicates an inflammatory process. After the examination, the gynecologist will make recommendations on what to apply to the sutures after childbirth to speed up their healing.

Post tags:

Not always postpartum period for a woman it turns out to be easy and cloudless. And it’s not just about caring for a newborn, but also about other problems. Serious discomfort can be caused by the consequences of tears and cuts, that is, internal sutures after childbirth. When do they heal? How soon should you see a doctor? These questions concern many women.

How do internal seams appear?

What causes internal seams? This is usually a rupture of the cervix, which can occur when natural childbirth. If a woman begins to push prematurely and her cervix dilates slowly, her tissue may tear. This type of premature pushing can occur in most women, which is why it is important to hold it until the cervix is fully dilated.

Internal tears are not always noticeable, so it is important that after childbirth the doctor carefully examines the woman and applies stitches. This procedure, by the way, is painless, since there are no pain receptors in the cervix, and anesthesia is not performed. Sutures can be placed in several ways. Basically, special surgical threads (catgut or vicryl) are used for them, which subsequently dissolve on their own.

What to do with internal seams?

As a rule, a woman does not need to do anything with these stitches - they do not require any ointments, douches or tablets.

How long does it take for internal sutures to dissolve after childbirth?

Two factors play a role here: the material from which the seams are made, as well as the severity of the tear. On average, the threads completely dissolve in 90 days. Sometimes the fusion of damaged tissue occurs earlier, and the threads simply fall off. Their remains are then visible on the underwear. And if you do not experience any pain or other alarming symptoms, then there is nothing to worry about.

In order for sutures to heal faster, it is necessary to follow all the rules of personal hygiene. Diet is also important. The fact is that in this case, constipation is extremely undesirable, since unnecessary efforts can negatively affect the condition of the seams.

You also need to follow a few simple rules - you should not lift weights, make sudden movements (for example, playing sports) in the first weeks after childbirth, and you should also abstain from sexual intercourse for one or two months.

Should I see a doctor?

During the first few days after giving birth, many women experience abdominal discomfort. Pain and throbbing sensations may also occur. For the first two or three days this is quite normal phenomena. And if they continue further, then you should immediately consult a doctor.

Others alarming symptoms there will be pain in the area of the suture, a feeling of heaviness in the uterine area, a sharp increase in body temperature, as well as purulent discharge, accompanied by an unpleasant odor.

These are signs that either the internal seams have separated, or inflammatory processes have arisen in them. In any case, only a doctor prescribes treatment. These may be procedures using special ointments or antibiotics, repeated stitches, or simply applying ice.

If nothing bothers you during the postpartum period, a preventive visit to the gynecologist should not be delayed either. The doctor should look at the condition of the scars, check whether there is any deformation of the uterus, or whether improper tissue fusion has occurred. All these problems can later develop into various diseases. Full recovery tissue loss occurs differently for each woman, but usually over a period of 3 to 6 months.

Manifestations of maternal trauma include injuries birth canal and uterus. Ruptures after childbirth occur in 5-20% of women. Damage to the uterus develops much less frequently - in one case out of 3000. The frequency of injuries to the ligaments and joints of the pelvic bones is even lower.

What kind of gaps are there?

Suffer mainly soft fabrics(perineum, vagina, cervix). Their injuries are usually observed in primiparous patients. If there is an abnormal course of the birth process and incorrect or untimely implementation of obstetric care, both during the first and repeated births, a serious complication may occur - uterine rupture. Stretching or damage to the pubic and iliosacral joints occurs when congenital feature– weakness of connective tissue.

Injuries to the perineum and vagina

These are the so-called external breaks, the causes of which are:

large fruit;
rapid course of the birth process;
weak labor activity, developed secondarily;
prolonged labor;
extensor insertion of the child's head into the pelvic ring, for example, the facial ring, when the child's head enters the birth canal not at its smallest size;
inappropriate sizes of the pelvis and fetus;
deformation of soft tissues by scars after previous births;
, at the end of pregnancy;
post-term pregnancy (more than 42 weeks);
improper breathing during the 2nd period or premature attempts;
use of obstetric forceps.

Damage to the vagina and vulva

Injuries to the vulva are accompanied by superficial tears of the clitoris and labia minora. Injuries to the lower vaginal region are often combined with perineal involvement. If the vaginal rupture occurs in the upper third, it can extend to the cervix. There are situations when the mucous membrane is not damaged, but the soft tissues underneath are crushed by the head passing through the birth canal. As a result, a hematoma, or hemorrhage, occurs in the deep layer of the vaginal wall.

The external genitalia are well supplied with blood, so even with minor damage it is likely heavy bleeding. The resulting defects are sutured, taking care not to damage the corpora cavernosa of the clitoris. For such an intervention, intravenous anesthesia is used if the woman has not previously had epidural anesthesia.

The submucosal hematoma is opened if its size is more than 3 cm. It is cleaned, and the damaged vessels are sutured. If the hemorrhage is very large, drainage strips are left in its cavity for several days, and sutures are placed on the tissue. Absorbable suture material is used, which does not need to be removed later.

If there is an injury to the upper part of the vagina, the doctor must carefully examine the cervix and examine the uterus to prevent the damage from spreading to these organs.

Perineal rupture

Usually develops during the 2nd stage of labor. It can be natural or occur as a result of perineotomy (artificial incision of the perineum to facilitate delivery).

There are 3 degrees of severity of pathology:

I – only the skin of the perineum and the vaginal wall in its lower part are damaged;
II – damage is added muscle structures pelvic floor and rupture of the posterior commissure;
III – deeper tissues are affected, in particular the sphincter or rectal wall.

A third degree tear is a serious injury. At improper treatment in the future it becomes the cause of fecal incontinence.

A rare but serious condition is a central rupture. The child is not born through the vagina, but is born through a hole formed in the middle of the perineum. The rectal sphincter and posterior commissure are not injured, but extensive muscle damage occurs.

There are three stages of the pathological process:

Excessive stretching of soft tissues, compression of them by the child’s head or pelvis and difficulty in the outflow of blood through the veins (externally this is accompanied by cyanosis of the skin).
Tissue swelling, characterized by the appearance of a peculiar skin sheen.
Compression of the arteries, pale skin color, malnutrition of soft tissues and their rupture.

To diagnose such injuries, the birth canal is examined immediately after the baby is born. Treatment of injuries is carried out in the first half hour. If regional anesthesia was not used during childbirth, the patient is given an anesthetic intravenously. The operation should be performed by an experienced gynecologist, because if the suturing is improper, the muscles of the perineum, vagina, and uterus subsequently prolapse, and scar deformation of this anatomical area and even fecal incontinence are possible. In case of muscle injury, they are sutured using absorbable sutures, and non-absorbable sutures are placed on the skin. They are removed after a few days.

Childbirth without perineal rupture takes place under the following conditions:

correct management of the process by the midwife and doctor;
teaching a woman how to behave during the birth of a child during pregnancy;
timely episiotomy (incision) if there is a threat of tissue damage.

Cervical injuries

Its rupture occurs during pushing, mainly in primiparous patients. His reasons:

scars after electrocoagulation, conization, laser exposure or cryosurgery of the cervix before pregnancy;
consequences of cervical rupture during previous births;
heavy weight of the child;
extensor or occipital presentation(his rear view);
rapid progress or incoordination of labor activity;
vacuum extraction to extract the fetus, use of obstetric forceps.

There are three degrees of injury severity:

I degree - accompanied by one- or two-sided damage up to 2 cm in length. Symptoms are often absent.
II degree - tissue divergence does not reach the edges of the cervix, but exceeds 2 cm in length. Damage to the blood vessels causes moderate bleeding, which does not stop after the release of the placenta and contraction of the myometrium.
III degree - severe damage involving the upper part of the vagina, often the adjacent uterine segment.

If a cervical injury is not accompanied by bleeding, it can be recognized by careful examination using mirrors. This manipulation is performed on all women in labor in the first 2 hours after the end of labor. If there is bleeding, examination and treatment begin immediately when the placenta comes out and its integrity is confirmed.

If a third degree rupture is suspected, the uterine cavity is examined manually.

Cervical injuries are sutured with catgut.

Damage to the symphysis pubis

Previously, this complication developed when using high forceps or using the Kristeller method for the birth of a large fetus. Nowadays, rupture of the symphysis pubis is observed extremely rarely, mainly against the background of symphysitis - softening of the connective tissue that forms the ligaments in this area. During the birth of a child, the pubic bones diverge by 5 mm or more, without returning to their original position. Damage to the articulation of the bones of the sacrum and pelvis is possible.

This complication is characterized by pain in the pubic area that occurs shortly after childbirth. It gets stronger as you open your hips and walk. The gait changes, redness and swelling appear in the affected area.

Used conservative treatment, in which a wide bandage is placed around the patient’s pelvis, which crosses in front, and a weight is suspended from its ends. This is how the pubic bones are mechanically pressed against each other. The disadvantage of this method is bed rest for several weeks. Therefore it is possible surgery, during which the bones on both sides of the womb are attracted to each other, for example, using a wire.

Birth trauma to the uterus

Internal ruptures during childbirth with capture of the uterine pharynx and itself muscle wall in half of the cases they are accompanied by the death of a child and can cause fatal outcome for the woman herself. In modern obstetrics, such a pathology rarely occurs, since predisposing factors of damage are recognized in time, and the patient is referred to.

Reasons for this serious condition– an obstacle to the child in the natural birth canal and pathology of the uterine wall that arose even before pregnancy. Uterine rupture can be incomplete or complete. Incomplete occurs in the lower part of the organ, not covered by the peritoneum, and does not penetrate into the abdominal cavity, unlike complete. Pathology can be observed in any part, and most often occurs at the site of a scar after a cesarean section or myomectomy.

Mechanical damage caused by an obstacle to the birth of a child is now rarely diagnosed. Risk factors:

narrow pelvis;
neoplasms of the pelvic organs;
large fruit size;
scars on the cervix or vaginal wall;
incorrect presentation or position of the baby.

Much more often, injury develops in the area of pathologically changed tissues. Disturbance of the normal structure of the myometrium occurs:

after surgical intervention;
with a large number of births (4 or more);
with numerous abortions or curettages;
after .

Obstetricians are increasingly using caesarean section surgery, which leaves a scar after healing. With repeated pregnancy, the tissues gradually weaken and “spread,” which intensifies during childbirth. Damage to the myometrial vessels leads to hemorrhage into the uterine wall, and only then does the organ rupture.

The obstetrician must be aware of the danger of violent injury to the uterus. Its threat is real in a situation where labor is stimulated using oxytocin in a multiparous woman with a large fetus and a pathologically altered uterine wall. In this case, the myometrium begins to contract intensively, and even the slightest difference in the size of the pelvis and the fetus leads to rapid rupture of the muscle wall.

Signs of a threatening breakup:

after the release of amniotic fluid, frequent, gradually intensifying, very painful contractions occur;
a woman worries not only during contractions, but also in the rest periods between them;
heart rate increases, shortness of breath appears;
the bladder is located above the pubis, urination is impaired, blood can be detected in the urine;
the abdomen takes on an “hourglass” shape due to the upward displacement of the contraction ring of the uterus;
the genitals become swollen.

Symptoms of incipient uterine damage:

signs painful shock– screaming, excitement, redness of the face;
convulsive nature of contractions, attempts appear when the head is located high;
bloody discharge from the birth canal;
and the death of a child.

With a complete rupture, suddenly appears during a contraction. sharp pain. Labor activity stops completely. Internal bleeding is accompanied by pallor, sweating, weakening pulse, dizziness and loss of consciousness. The fruit dies and may move to abdominal cavity. Blood continues to flow from the birth canal.

The entire process from start to completion of the rip takes just a few minutes.

Sometimes damage develops during the last push. Is born healthy child, then the afterbirth comes out. Signs of blood loss gradually begin to appear. The diagnosis is made after manual examination of the uterine cavity or during emergency laparoscopic surgery.

An incomplete rupture is characterized by the following symptoms:

pallor, palpitations, decreased blood pressure;
pain in the lower abdominal segment, which often radiates (“gives”) to the leg;
bloating and soreness of the abdomen, which gradually becomes diffuse.

In case of threatening or incipient damage, immediate C-section, intense infusion therapy(intravenous infusion of solutions, if necessary, blood products). If possible, the uterus is preserved by suturing the defect. If the injury is significant, amputation is performed.

Prevention of uterine ruptures consists of careful management of pregnancy and childbirth in patients at risk.

Possible complications

Tissue trauma during childbirth can have serious consequences:

hemorrhage with the formation of a hematoma;
suppuration of the resulting accumulation of blood with the formation of an abscess;
suture infection;
swelling that makes it difficult to urinate.

Subsequently, a scar is formed, which causes deformation of the cervix. In some cases, this leads to miscarriage of subsequent pregnancies and often serves as an indication for cesarean section. In severe cases, cervical plastic surgery or removal of scar tissue using laser techniques is necessary. Another complication is, or “eversion” of the cervical canal.

Damage to the vagina and labia usually does not have serious consequences. If the clitoris is injured, its sensitivity may temporarily decrease. If the skin is damaged, a small scar will form.

Recovery period

It is much easier to prevent soft tissue tears than to treat them. If an injury does occur, it is necessary to follow doctors’ instructions for a speedy recovery of health.

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

The most common of them (perineal injuries) disappear after 4-5 weeks. For favorable healing in the first days, the sutures are treated with antiseptics, for example, a solution of brilliant green or hydrogen peroxide. The patient is then given the following recommendations:

wash with water after each urination or defecation from front to back;
dry the seam area well with a towel or paper napkin;
change sanitary pads as often as possible, ideally every 2 hours;
provide air access to the perineal area;
walk more, but without discomfort or pain;
avoid constipation, use laxatives if necessary, preferably glycerin suppositories;
If pain intensifies, discharge of an unusual color or odor appears, or temperature rises, you should immediately contact a gynecologist.

Both after an episiotomy and after perineal tears, it is not recommended to sit for at least a week. Then it is better to sit on an inflatable rubber ring to avoid fabric tension and seams coming apart.

Recovery after childbirth complicated by ruptures depends on their location and severity. However, when early detection and suturing, severe complications are uncharacteristic, and in the future the woman can give birth naturally.

Prevention

To prevent injury, the mother must properly prepare for childbirth, and during the process itself, calmly follow all instructions from the medical staff.

Preparing during pregnancy

To learn how to give birth correctly without ruptures, you should visit the “School for Pregnant Women”, which operates in almost every antenatal clinic. If this is not possible, you can ask all your questions from the doctor leading the pregnancy.

rhythmic contraction of the muscles of the perineum, anus and vagina ();
imaginary grasping of the handles of a large bag with the crotch in a half-squat position and lifting it with straightening the legs;
imaginary movement of an elevator up and down the vagina with tension in the corresponding muscles.

Such gymnastics improves blood circulation in the tissues of the pelvic floor, helps to strengthen them and increase elasticity.

It is very important to become familiar with the periods of labor, breathing patterns and behavior during contractions and pushing.

About a month before the expected birth of the baby, almond or other oils can be regularly applied to this area to moisturize and nourish the perineal tissues. vegetable oil, to which, if desired, a few drops of essential oil of eucalyptus, lemon, and coniferous trees are added. It is undesirable to introduce any substances into the vagina, as this can provoke an increase in the tone of the uterus and.

How to avoid ruptures during childbirth?

Everything depends not only on the woman’s efforts, but also on the speed at which the child passes through the birth canal, its weight, position and many other factors. If there is a threat of soft tissue rupture, doctors make an incision, which heals much faster.

An episiotomy operation is performed when there is a threatening rupture of soft tissues in the 2nd stage of labor. The doctor makes a small incision in the skin of the perineum from the center to the side. No anesthesia is required. If epidural anesthesia is used, such an intervention is completely painless for the patient. Immediately after labor is completed, the incision is carefully sutured.

How to push correctly?

Start only at the command of the midwife, when the cervix is dilated enough for the head to come out.
Do not push as the head passes through the cervix, as the physician delivering the baby will also warn you about.
Before pushing, inhale smoothly and quickly, and then exhale forcefully for 15 seconds, while simultaneously straining your abdominal muscles. During one attempt, repeat this exhalation three times.
In the interval between attempts, relax as much as possible.
If you can’t push, start breathing “like a dog” - fast and shallow.

Application of obstetric gel

Obstetric gel for ruptures Dianatal will help facilitate the birth of a child and prevent tissue damage. It forms a lubricating film on the surface of the vagina, reducing friction on the baby's head. Studies have shown that the use of such a gel not only speeds up labor, but also protects the perineal tissue.

The drug is available in two forms, the first of which is intended for treating the birth canal during cervical dilatation, and the second - during the pushing period. The gel is inserted by the doctor into the vagina using an applicator. It is sterile and does not contain harmful substances and is the only currently licensed product to facilitate labor and protect maternal tissue.

Dianatal obstetric gel was developed in Switzerland, produced in Germany, and its only drawback is high cost. This drug is not included in the list of medications that maternity hospitals provide as part of state guarantees of free medical care, in other words, according to the policy. If a woman is going to give birth in a paid clinic, she should clarify whether such a gel will be used. You can purchase it yourself by giving it to your doctor before giving birth.

Childbirth is a natural process, but it is painful and traumatic for a woman. During passage through the birth canal, the child stretches the maternal tissues, which leads to small wounds and serious breaks. If there is a threat of rupture, as well as premature birth, the fetus is too large and other problems, the doctor performs an incision (episiotomy). Cuts and tears are sutured for fast healing. How to behave, how long it will take to recover, what complications there may be with sutures on the perineum - look in this material.

Sutures on tears after childbirth

Rapid labor, insufficient tissue elasticity, and incorrect behavior of the woman in labor (starting to push too early) lead to the appearance of ruptures. A correctly and timely episiotomy is much better than a rupture: the doctor uses a sharp scalpel to make a neat incision that is easy to stitch up. Lacerations, which occur during childbirth, require more stitches, can leave behind an unsightly scar and take up to 5 months to heal (internal stitches).

Types of postpartum sutures:

Internal - located on the walls of the vagina, cervix. Usually performed with self-absorbable threads.
External - located on the perineum. They are performed with both self-absorbable and regular threads.

External seams on the crotch

The longest and most painful process in childbirth is the dilatation of the cervix. She needs to go a long way from about 1 cm of dilation (this is how women usually end up in the maternity hospital) to 8–10 cm. The process is accompanied by strong contractions and can last from several hours to several days.

Compared to dilation of the cervix, the birth of the baby itself takes a matter of minutes. At the midwife's signal, the woman begins to push, helping the baby pass through the birth canal, and soon he is born. Attempts take on average from 20–30 minutes to 1–2 hours. This process should not be delayed; it can lead to asphyxia in the newborn. Therefore, when the doctor sees that independent birth is impossible or difficult, he makes an incision.

An incision (episiotomy) is a surgical cut through the perineum and back wall of the vagina. There are perineotomy (incision from the vagina to the anus) and mid-lateral episiotomy (incision from the vagina to the right ischial tuberosity).

Types of episiotomy: 1 - child’s head, 2 - mid-lateral episiotomy, 3 - perineotomy

By for some unknown reason Women in labor try their best to avoid tears and especially incisions. On women's forums you can often find the proud “not torn,” which generally means good preparation mothers, normal course of childbirth, normal sizes fetus and high elasticity fabrics. But when the doctor talks about the need for an incision, and the woman in labor actively protests, is indignant and even screams, this is fraught with negative consequences, primarily for the baby.

Possible consequences for the child:

Damage cervical region spine.
Damage nervous system due to lack of oxygen.
Hematomas on the head, fractures and cracks, hemorrhages in the eyes due to excessive pressure on the soft bones of the skull.

An even and neat cut 2–5 cm long will help mother and child get to know each other faster. After childbirth, the doctor will close it with a continuous cosmetic suture, which, if properly treated, heals very quickly, in about a month. After healing, it looks like a thin “thread”, slightly lighter in color than the skin.

It's a completely different matter if we're talking about breaks. Firstly, it is impossible to predict in which direction the fabric will tear and to what depth. Secondly, it has an irregular shape, torn, even crushed edges are difficult to connect as they were. In this case, several stitches are required; in some cases (for third-degree tears that reach and extend to the vaginal walls), general anesthesia may be required.

What are they stitching with?

Episiotomy incisions and minor perineal tears are sutured with self-absorbable sutures. They are much more convenient, they do not need to be removed, and within 2-3 weeks the threads dissolve without a trace (depending on the material!). Small debris and nodules may come out with the discharge and remain on the pad or underwear.

Deep injuries and cuts are sutured with nylon, vicryl or silk threads. The doctor will remove them in 5–7 days. They tighten the wound tightly and ensure good healing.

In some cases (for severe tears), metal staples are installed. They are removed in the same way as nylon or silk threads, but can leave small scars and holes.

Example of a seam after removing metal staples - holes in the skin are visible

Seam care

While you are in the maternity hospital, under the supervision of specialists, a nurse takes care of the suture. It is usually treated daily with a solution of brilliant green. After discharge, you should continue to care for your suture as directed by your doctor. If everything heals well, it is enough to follow the rules of hygiene, wash yourself after each visit to the toilet, do not wear tight underwear, use natural pads, and provide air access. For inflammation and suppuration, the doctor prescribes therapy (levomekol, solcoseryl, and in especially severe cases, antibiotics).

Internal seams on the vagina, on the cervix, on the clitoris

Internal sutures are placed on the cervix and vaginal walls in case of ruptures during childbirth. Doctors say the main cause of injuries is improper behavior of the mother in labor. Early attempts, when the cervix has not yet opened, lead to its rupture. “Aggravating” circumstances are operations on the cervix, age-related decrease in tissue elasticity. Ruptures of the vaginal walls are provoked, in addition to the above reasons, by the presence of old scars, emergency childbirth, and a high position of the vagina relative to the anus. Of course, one cannot deny the possible guilt of the obstetrician - incorrect tactics also lead to injuries.

In some cases, after applying internal sutures to the vagina, mothers complain of pain in the clitoris. The clitoris itself is not sutured, but the seams and ends of the threads may be located next to it, stretching and injuring the delicate area. In general, if the discomfort is too severe, it is best to see a doctor. Gradually the threads will dissolve and the pain will go away.

What are they stitching with?

Internal seams are made only with absorbable threads. The reason is complicated access to injuries. Most often, catgut or vicryl, sometimes lavsan, are used for this. The final dissolution time for all types of self-absorbing materials is 30–60 days.

Seam care

Internal seams do not require special care. It is enough for the mother to follow the doctor’s recommendations, not lift heavy objects, abstain from sexual activity for 1–2 months, and maintain personal hygiene. Be sure to visit the gynecologist at the appointed time, even if nothing worries you, only a doctor can assess the condition of the tissues, the speed of healing and other factors.

Read more about caring for internal and external scars in the article -.

How long do stitches take to heal?

Be prepared for discomfort and discomfort in the area of the incisions and tears for about 2-3 months. The recovery process is individual for each woman, depending on her well-being, state of health, pain threshold, and age. Some people already feel like they were before pregnancy after two weeks, while others need a year or more to recover.

Take your time to return to an active sex life! Restrictions are not the whim of the doctor and not his reinsurance, but primarily concern for your health. Within 2–3 months after childbirth, sexual intercourse will be painful until the injured area fresh scar will not restore sensitivity.

Something went wrong if:

The suture site bleeds after discharge.
Even at rest, you feel pain inside, a feeling of fullness (may be a sign of a hematoma).
The seam becomes inflamed, discharge with an unpleasant odor occurs, and the temperature may rise.

All these signs, as well as other changes in the condition that seem suspicious to you, are 100% reason to consult a doctor immediately.

Self-absorbing internal sutures

The recovery time depends on the material and severity of the tear. Catgut disappears within 30–120 days, lavsan - 20–50 days, vicryl - 50–80 days. If you feel good, there is no pain or discomfort inside, you are full of strength and energy - everything is fine. Pay attention to your diet, you need to avoid constipation. If necessary, take a laxative as directed by your doctor.

External seams

With proper care and no complications, the sutures in the perineum will heal completely within 1–2 months. To do this, the mother should rest more, it is recommended to stay in bed if possible, and maintain hygiene. One of the reasons for frequent inflammation of external seams is postpartum discharge from the uterus. Change your underwear as often as possible, provide access to air (if possible, you can avoid underwear, at least at home), use special pads with antibacterial impregnation.

The external suture during episiotomy (regular) ceases to bother you after about 2 months

When to remove threads from external seams

Staples and threads are removed 3–7 days after birth, most often on the fifth. The doctor assesses the condition of the woman in labor, the speed of healing and, based on the information received, makes a decision on discharge.

Does it hurt to remove the threads?

It all depends on your pain threshold. The procedure is unpleasant, but quick. If you are afraid of pain, ask your doctor to spray a local anesthetic on the stitch.

When can you stand up and sit down with stitches after childbirth?

For two weeks you can only lie down or stand. Sitting is strictly prohibited! A reclining position, leaning on the headboard of the bed, is allowed. This also applies to check-out; warn your relatives in advance that the entire back seat of the car will be occupied by you and the baby.

Why such strictness? If you try to sit down ahead of schedule, it is quite possible for the seams to diverge. And this is not only painful, but will also require re-suturing, doubling the wound healing time.

How long do stitches hurt?

Pain, pulling sensations and discomfort from external and internal stitches should go away within two weeks after birth. If three weeks have passed and you still have a lot of pain where the stitches were placed, be sure to tell your gynecologist. Do not delay, in this case it is better to be on the safe side to avoid possible consequences.

Symptoms of complications on sutures after childbirth:

Pain (for external seams), sensation of pulsation and twitching inside (for internal seams).
Swelling of the suture, suppuration, is often accompanied by a sharp increase in body temperature.
Seams coming apart.
Continuous bleeding.

If you experience any or all of the symptoms, consult your doctor. Don’t wait, don’t use advice from the internet, don’t trust recommendations from friends and acquaintances. Frivolity is unacceptable here!

The seam has come apart - reasons:

Mom tried to sit up before her due date.
Lifted weights (more than 3 kg).
Returned to sexual activity.
Accidentally caused an infection in the wound.
Didn't follow hygiene rules.
She suffered from constipation.
She wore tight synthetic underwear.
Didn't take proper care of the stitches.

The problem can be recognized by a feeling of burning or itching at the suture site, swelling (perineum), pain and tingling, bleeding, increased temperature, and general weakness. What to do? Immediately go to see your doctor, and in especially serious cases, call an ambulance.

"Microlax" after childbirth with stitches

Let us separately dwell on the problem of constipation. Strong efforts during defecation can lead to divergence of the external and internal seams. A laxative will help you, but if you are breastfeeding, your pediatrician should prescribe the drug. As emergency remedy Microlax microenemas are suitable, they are safe for nursing mothers, they will quickly and painlessly solve a delicate issue. They have a mild effect, the result occurs within 10–15 minutes after use.

The stitches hurt

If everything is in order, the healing process is going well, the gynecologist finds no problems, but the stitches hurt - what is the reason? Perhaps you have low pain threshold, your tissues need more time to recover, or your rhythm of life is too active at the moment. In any case, if you are confident in your doctor (it may be worth consulting with another specialist), allow your body to rest a little. You should not return to active training, lift weights, sit on a hard chair for a long time and do daily general cleaning. All this will have to wait.

Does pain occur only during sexual intercourse? This is a temporary phenomenon, try changing your position, use lubricants. Gradually, your body will return to its previous shape and adapt to the changes.

Sutures become inflamed and festered, causes, treatment

Inflammation and purulent discharge appear when an infection enters the wound. It can penetrate both from the woman’s body (postpartum discharge, infections not treated before childbirth) and from the outside, if hygiene rules are not followed. Your doctor should prescribe the final treatment regimen for you.

Drugs used:

Anti-inflammatory and healing ointments: levomekol, syntomycin, Vishnevsky ointment and others. They will relieve swelling, have an antiseptic and antibacterial effect, and stop the inflammatory process.
Suppositories, in particular, “Depantol”, “Betadine” - accelerate the healing of mucous membranes, treat infectious and inflammatory diseases of the genital area.
A course of antibiotics, antipyretic and anti-inflammatory drugs - the doctor will select therapy in such a way that breastfeeding can be maintained.

Suture granulation, what is it, treatment

Granulations are new tissue that grows during wound healing (healthy cells are formed, blood vessels etc.). Normally, this is a natural process, but sometimes granulations grow at the site of the sutures after childbirth and can cause discomfort, feel like small growths. Treatment is at the choice of the gynecologist. Most often, granulations are removed locally or in a hospital.

Polyps on the suture, what they are, treatment

A polyp usually refers to the granulations or pathologies already mentioned above during scar formation. They can also disguise condylomas and papillomas. They look and feel like strange growths (one or more formations) at the suture site and around it. Treatment is usually surgical.

Seal (bump) on the seam

If a fairly large lump is felt on the seam, the first thing you should do is visit your gynecologist. Most often, a nodule from a self-absorbing suture is mistaken for a lump, which will disappear fairly soon. But there may be other options. In addition to the granulations and papillomas listed above, an abscess with purulent contents may form at the suture site. This dangerous symptom, which signals improper suturing, infection of the wound, or rejection of the threads by the body. Seek help immediately.

How to speed up the healing of stitches

First and foremost: none of the methods should be used before consulting a doctor!

Give up underwear, especially during sleep. If there is heavy postpartum discharge, you can sleep on a special absorbent diaper.

Take care of your diet. You need enhanced nutrition, forget about extra calories for a while. The body has experienced stress and needs healthy, high-quality products.

Perhaps the recipes will help you traditional medicine. Oil promotes healing of injuries tea tree, sea buckthorn oil.

When can you wash after giving birth with stitches?

Showering is allowed and recommended after each visit to the toilet. But with a bath, and even more so with a visit to the bathhouse and sauna, you will have to wait a little longer. On average, doctors allow you to take a bath two months after birth, if the healing process is successful, without any problems. You can also focus on your body, if postpartum discharge has not stopped yet, you should not rush to take a bath. The fact is that for a long time after childbirth, the cervix remains slightly open and bleeds, and tap water cannot be called sterile. Bacteria, once in a favorable environment, begin to actively multiply, triggering inflammatory processes in a weakened body.

Cosmetic stitches after childbirth

The cosmetic seam after healing is almost invisible on the skin. He came to gynecology from plastic surgery. Main features: passes inside the tissue, has no visible signs of needle entry and exit.

For cosmetic sutures, self-absorbable threads (lavsan, vicryl) are usually used. It is performed on smooth, neat cuts and passes through the thickness of the skin in a zigzag manner, called continuous.

Regular and cosmetic suture after childbirth during execution and after healing

Caring for sutures - a reminder for a woman in labor

Change the sanitary pad every two hours, regardless of the presence of discharge. If possible, avoid wearing underwear.
Do not forget about treatment with antiseptics if prescribed by a gynecologist.
After visiting the bathroom, take a shower, and if this is not possible, wipe the perineum with a sterile napkin using gentle blotting movements.
Do not sit down for two weeks.
Monitor your diet, exclude gas-forming and fixing foods (baked goods, cereals, etc.). If necessary, take a laxative and do microenemas in consultation with your doctor.

With proper care, external and internal seams, regardless of the material with which they are made, heal quickly and do not leave large scars. Take care of yourself, follow the recommendations of the gynecologist, and very soon you will be able to return to normal life.

Nature has endowed a woman with an amazing ability to easily endure pain for the sake of birth. healthy baby. After all, what are a few hours compared to happy life, in which the most expensive little man in the world will appear? But still, expectant mothers are rightly tormented by the question - how to avoid ruptures during childbirth and is this even possible?

As they say, nothing is impossible, but, alas, no one can give you guarantees. And yet it is worth studying this phenomenon, if only in order to orient yourself on how to behave during childbirth.

It must be said that ruptures can occur both spontaneously and due to medical intervention (so-called violent injuries). For example, when using forceps, pulling the child by the legs, rough palpation of the cervix, etc. The general prerequisites for internal ruptures during childbirth are as follows:

Healed or aggravated inflammatory processes and infections of the genital organs, as well as “female” diseases, such as thrush, vulvovaginitis, etc. They reduce muscle elasticity, which leads to ruptures;
Ineptitude of the woman in labor . If you don’t know how to behave, breathe, how and when to push, or you simply panicked and let the process take its course, a perineal rupture may well occur if the doctor does not make an incision in time. To prevent this from happening, it is necessary to overcome fear, listen to yourself and follow the instructions of the obstetricians. By the way, a surgical incision (episiotomy) is much safer than a spontaneous rupture of the perineum during childbirth - it is easier to stitch up, and the sutures heal much faster;
If delivery is too fast When the fetus rapidly moves along the excretory canal, there is always a risk of stretching or rupture of the symphysis pubis. I must say that this happens quite rarely. More often, stretching of symphysitis occurs, because this type of damage is preceded by loosening of the tissues of the pubic and sacroiliac joints during pregnancy under the influence of the hormone relaxin. Basically, a rupture of the symphysis pubis during childbirth makes itself felt only after a couple of days and is a low-risk injury;
Sluggish labor , accompanied by swelling of the perineum, and subsequent stimulation by hormones can lead to cervical rupture, accompanied by heavy bleeding, which continues even after the birth of the placenta. Also, this type of damage can be caused by premature, active or untimely attempts. Then the rupture occurs against the background of non-dilation of the cervix to the desired size. A large fetus in a primiparous woman, a narrow pelvis in a woman in labor, a breech presentation of the fetus, or surgery can also cause damage to the cervix;
A more severe injury is uterine rupture during childbirth, accompanied by a number of serious complications, up to the removal of the organ. Such complications can cause repeat birth after cesarean section , mature age a woman in labor carrying her first child who has previously undergone surgery on the cervix (for example, removal of fibroids). As you can see, most often uterine rupture during childbirth occurs along an old scar. So, previous abortions and other surgical interventions greatly increase the risk of damage. It should be noted that this type of rupture is considered the most severe form of complications during childbirth. Doctors have to make every effort to recover a woman in labor, who requires constant medical supervision. Typically after uterine rupture vaginal birth are no longer possible;
Internal ruptures during childbirth can also occur due to the midwife's fault , if she does not exercise caution when removing the head and shoulders of the fetus from the vagina. Even experienced qualified medical workers are not immune from such a turn of events;
Damage is often caused by tone of the pelvic floor and uterine muscles . Most often, gymnasts, dancers and women who enjoy horse riding suffer from this. With these undoubtedly useful for general health exercises, the muscles that are developed are not those that are necessary for easy childbirth;
Such a physiological feature of a woman as "high crotch" , in which the distance from the vagina to the anus exceeds 7 cm;
Banal panic of a woman in labor , up to the point of insanity. Alas, in this case, no one except you yourself can influence the situation. Before giving birth, tune in to the result, remember that the baby is also ill and in pain, and the more afraid you are, the more painful the process is for him. So you have to pull yourself together for a successful outcome.

As you can see, there are many reasons why internal ruptures can occur during childbirth, and all of them are somehow related to the woman’s health and lifestyle. Therefore, it is necessary to prepare for the process of bringing a baby into the world in advance - both physically and psychologically. Fortunately, these days there are many preparatory centers for pregnant women and a lot of information on the Internet.

Complications after labor ruptures

Let's consider the consequences of ruptures during childbirth using the example of damage to the perineum and cervix. These two types are the most common and are fundamentally different from each other.

As you understand, the perineum is on the outside and the tears on it are visible naked eye. The uterus is an internal organ, but its damage is detected literally from the first minutes, “thanks” to bleeding and palpation.

Perineal ruptures, like uterine ruptures, come in 3 degrees.

The first type of damage is divided into:

injury by back wall;
trauma to the anus, sometimes affecting the rectum;
injury to the pelvic floor muscles.

If the perineal rupture occurred spontaneously (without surgical intervention), then subsequently the woman may experience pain and urine retention when urinating; when the suture heals, burning, itching and other uncomfortable feelings often occur that can last up to six months.

In situations where ruptures were left unsutured, and their weakly fused and slowly healing edges were subjected to repeated damage, there were frequent cases of tissue infection, prolapse and prolapse of internal organs, fecal and urinary incontinence, and cervical erosion. So, as you can see, timely sutures are the key to rapid healing of perineal injuries.

The tissue recovery period is shortened if a surgical incision was made, the smooth edges of which heal faster, leaving minor scars. In general, the presence or absence of complications depends on the care of the wound and the woman’s responsibility - how often he visits the doctor, how carefully he follows his recommendations, etc.

With cervical ruptures, everything is not so simple; they are also divided into 3 degrees:

I – injury up to 2 cm in size;
II - injury measuring 2 cm or more;
III – injury reaching the vaginal vault.

It is clear that the consequences of ruptures during childbirth depend on the severity of the cervical injury. It is quite possible that you will be lucky and will not feel any discomfort in the area of the sutures, and the wounds will heal without additional treatment. But still, such injuries do not disappear without a trace.

In any case, the elasticity and ability to contract the uterus will be reduced, and the cover of the organ itself is no longer solid. In addition, if the sutures were placed crookedly (and this is not uncommon, because for suturing, the cervix must first be removed to the surface), rough scars may form, which will later make themselves felt with unpleasant sensations.

But even if a perfect suture is applied, the woman is not immune from inflammatory processes in the area of the rupture. Such a complication during subsequent pregnancy can cause isthmic-cervical insufficiency. Against the background of this disease, there are often early miscarriages and infection of the uterine cavity.

If the sutures placed in the cervical area have not healed well, the organ will be susceptible to inflammatory processes, V advanced stage leading to infertility, pathologies during pregnancy and cancer.

In any case, the process of delivery leaves a deep mark on the uterus, even if there were no ruptures. The shape and size of the organ will never be the same as before childbirth.

We cannot remain silent about the consequences that may entail. uterine rupture– the most severe form of birth injuries. With the so-called threatening rupture, overstretching of the lower segment occurs, where the fetus gets stuck, the organ becomes shaped like an hourglass. In such a situation, contractions become very painful and attempts are unproductive. Unfortunately, with such symptoms it is almost impossible to save the baby.

Threatening uterine rupture is also characterized by a high-standing fetal head above the entrance to the pelvis, protrusion above the pubis due to edema of the paravesical tissue and overstretching bladder. The onset of a rupture is indicated by external bleeding from the vagina or the presence of blood in the urine.

The easiest way to establish a complete uterine rupture is when the fetus moves into the peritoneum and dies as a result of asphyxia. The mother's belly becomes deformed. A timely diagnosed injury is the key to a woman’s life. The fetus, unfortunately, does not survive in such cases. When the doctor has determined that a rupture has occurred, labor must be stopped immediately.

If the pathology was discovered only after the birth of the child (and this happens, for example, when rapid labor when the uterus bursts after the fetus is delivered), complications can lead to such serious illnesses, such as diffuse peritonitis and sepsis. In this case, the clock counts and a delay in treatment of a couple of minutes can lead to death.

In fairness, it is worth noting that rupture of the uterine body, subject to preventive measures and constant monitoring of pregnancy by a doctor, is practically impossible. After all, having identified the prerequisites in time, the gynecologist will simply offer the expectant mother a caesarean section in the name of saving the child and herself.

How are tears treated?

When ruptures occur during childbirth, treatment consists of suturing performed directly on the table. The faster and better the suture is applied, the fewer negative consequences the injury to the birth canal will bring. However, there are cases when suturing a third degree tear is postponed until the morning. For example, if there is no anesthesiologist on site at the moment. In this case, doctors may consider it advisable to perform the operation later rather than carry out the procedure unsatisfactorily.

Anesthesia plays an important role in suturing the perineum - local anesthesia will not only make the operation easier for the woman, but will also help doctors to open the wound well, determine the direction of the rupture and check internal organs for damage. As you understand, without anesthesia, such actions will cause enormous discomfort to the mother in labor.

So, how to stitch up a perineal tear? A lift or speculum is inserted into the vagina to better open the wound. Sometimes the doctor uses the index and middle fingers, which are removed from the womb as the tear is sutured. Extremely important point is an accurate comparison of the edges of the wound. Especially in a situation with third degree trauma. Otherwise, over time, the stitching site will begin to ache and a repeat operation may be required. In addition, suture dehiscence in the sphincter area is very difficult to diagnose. So it’s better to be patient right away and let the doctor do everything right than to experience unpleasant sensations again later.

Suturing the cervix is carried out using a slightly different technology. Anesthesia is not used for this operation.

The procedure is carried out in several stages:

After examination and palpation, when the fact of rupture is established, the cervix is pulled to the surface with bullet forceps;
The organ is retracted in the direction opposite to the injury;
Begin suturing with catgut from the upper edge of the wound, slightly retreating from the site of injury. The uterine mucosa is not sutured.

No special care is required for sutures on the cervix. The sutures are not removed - the threads gradually dissolve and come out spontaneously when the woman goes to the shower or toilet. According to some women in labor, they resemble thin transparent worms.

In the case of a uterine rupture, doctors take emergency measures.

Labor is urgently stopped through deep ether anesthesia;
Depending on the condition of the woman in labor, a caesarean section or fetal destruction operation is performed. In any case, immediate transection is performed without first removing the fetus. The actions of doctors are aimed at saving the woman in labor; the baby, as a rule, cannot be saved;
At the same time, anti-shock therapy and measures to combat collapse are carried out;
Depending on the severity of the injury, the uterus is sutured, supravaginal hysterectomy (removal of the uterine body) or extirpation (removal of the entire organ, including the cervix).

Caring for seams

After childbirth, as a rule, it is enough to follow basic hygiene and safety rules. Also, after suturing the perineum, a woman cannot sit on a chair for 2 weeks. You can sit on the toilet on the first day after giving birth.

At home, perform the washing procedure in the morning and evening, as well as after each visit to the toilet. It is necessary to use a hypoallergenic gel for intimate hygiene. After washing, you need to apply a solution of potassium permanganate or brilliant green to the seams to dry the wound.

Avoid synthetic panties and shapewear - this can lead to deformation of the seams, poor circulation and diaper rash. groin area. In addition, in the humid, stuffy environment created by underwear made from non-breathable material, bacteria multiply well.

Also in comprehensive care special nutrition is included behind the stitches. Basically, this is the exclusion from the diet of foods that have a fixing effect. To avoid injuring the rectum with hard stools, you can consume vegetable oil before meals.

Preventive measures before and after pregnancy

To survive childbirth without tears or incisions, you need to thoroughly prepare. And it is better to start preventive measures before you become pregnant.

When planning to conceive, start doing yoga and doing Kegel exercises - they will teach you how to properly tense and relax the vaginal muscles, strengthen the pelvic ligaments and increase tissue elasticity.

Once you become pregnant, continue to perform the complex and add a few exercises to it:

While standing, raise your knees as high as possible to your chest;
Lean against the back of the chair. Alternately, smoothly stretch your legs back as far as possible;
Place your feet wider than shoulder-width apart with your toes facing out. Do a deep plie and stay in this position for a few seconds;
Without leaving this pose, make springy swings up and down;
Standing, interlace your legs, tighten your sphincter muscles tightly, and walk 10 steps forward and backward. Number of repetitions – 10;
Perform the previous exercise with the ball held between your thighs;
Lie on your side, retract your sphincter and do a few swings upper leg. Roll over to the other side and repeat.

These exercises will help not only avoid injuries, but also improve your sex life and strengthen the health of the female genital organs.

But best prevention ruptures during childbirth is special massage crotch. It can be performed at any stage of pregnancy, and from 28 weeks the intensity and frequency of sessions can be increased.

You should start with an interval of 1 week, then massage at intervals of three days, and finally every other day. But a couple of weeks before the expected birth, it is worth switching to daily sessions.

First, stock up on special hypoallergenic oil for intimate areas. It can be purchased at a pharmacy or a store for expectant mothers. You can also use olive, almond, and calendula oils. But do not forget to consult a gynecologist. When treating thrush, herpes and other infections, massage should be postponed, otherwise the genital organs may become inflamed.

So, if the doctor has confirmed that there are no contraindications and has given, so to speak, the “green light”, you need to proceed directly to the massage. You can do it yourself, or involve your beloved husband in this activity. Just don’t forget about the original goal, otherwise you risk turning the procedure into foreplay.

Wash your hands with a sponge and antibacterial soap;
Apply the oil to the labia, fingers and rub around the circumference of the vaginal slit;
Relax and insert your index or middle finger in the vagina on 1 phalanx;
Using gentle movements, draw a semicircle on the back wall (imagine, for example, drawing a smiley face);
Add a second finger and increase your range of motion. But be careful not to cause yourself discomfort and damage the mucous membrane;
Gently stretch the vagina until you feel a slight tingling sensation. It's great if you experience a vaginal orgasm.

Gynecologists consider this simple procedure to be the most effective prevention ruptures during childbirth.

Resumption of sexual activity

After a normal vaginal delivery, gynecologists allow the woman to return to intimacy after the uterus is free of residual blood. But you will be given the green light for sex after childbirth no earlier than 2-3 months later.

In this situation, the support of the newly made daddy is very important. He should not put pressure on a woman, but must support and cherish her. After all, discomfort in sexual life exists even after childbirth without pathologies. What can we say about those that were accompanied by significant gaps.

In addition, the structure and size of the female genital organs change, and spouses will have to reconsider their sex life. In any case, avoid positions in which the penis puts pressure on the suture sites.

Despite the difficulties that disruptions during childbirth can cause, we wish you a speedy recovery and improvement in marital relations.

How to avoid tearing during childbirth

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