Main causes and etiology
Damage to the cervical tissue during childbirth is provoked by various anatomical features and obstetrical factors.
The main causes include:
- Cicatricial changes following surgeries, coagulation, laser exposure, or knife and electrosurgical excision.
- Large fetus.
- Occiput posterior position and deflexion head presentations.
- Labor abnormalities, including dyscoordination, precipitous or rapid labor.
- Surgical interventions: obstetric forceps, vacuum extraction, or destructive operations.
Classification by depth of injury
Depending on the extent and depth of the tissue defect, three degrees of cervical tears are distinguished:
- Grade I — defects no more than 2 cm in length, located on one or both sides.
- Grade II — tears with an extent of more than 2 cm, but not reaching the vaginal fornix.
- Grade III — the most severe injuries, reaching the vaginal fornix.
Briefly: answers to topical questions
What are the clinical symptoms of cervical tear in the early postpartum period?
- Grade I tears — as a rule, are asymptomatic.
- Deeper tears — are accompanied by bleeding due to damage to the descending branch of the uterine artery, which begins immediately after the birth of the child, with bright red blood flowing in a trickle even before the separation of the placenta and continuing after the birth of the placenta even with a well-contracted uterus.
With the help of what instruments is the diagnosis of cervical tears performed?
- Specula — vaginal specula are used for visual inspection of the cervix.
- Soft clamps — are used in combination with specula for mandatory inspection of the cervix in all postpartum women immediately after delivery.
What suture material and what types of sutures are used to repair cervical tears?
- Sutures — interrupted (nodal), single- or double-row.
- Single-row suture — needle insertions and exits are made through all layers, and the first suture is placed slightly above the upper angle of the tear.
- Double-row suture — the first row consists of mucomuscular sutures with knots in the lumen of the cervical canal, and the second row consists of intermuscular sutures with knots on the side of the vaginal part of the cervix.
- Suture material: not specified in the cited sources.
Degrees of cervical tears are easy to remember by the number 2: Grade I — up to 2 cm, Grade II — more than 2 cm (but not reaching the fornix), Grade III — reaching the vaginal fornix.
Class and exam questions
Which parturients are more likely to experience cervical tears?
This pathology is more often observed in primiparous women, as well as in the presence of cicatricial changes after previous surgeries or manipulations (coagulation, laser, excision).
What is the direction of cervical tears?
In the vast majority of cases, tears propagate from bottom to top — from the external os towards the internal os.
How are tears classified by depth?
Three degrees are distinguished: Grade I (up to 2 cm on one or both sides), Grade II (more than 2 cm, but not reaching the fornix), and Grade III (reaching the vaginal fornix).
What else to study on this topic
- Restoration of tissues of the posterior vaginal wall and perineal skin
- Technique for repairing Grade II perineal tears
- Step-by-step repair for Grade III perineal tears
- Prevention of tears and types of perineal incision
- Comparison of perineotomy and episiotomy
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