Cervical Tear
The following is important for cervical tear:
- Review in lithotomy position and in good light.
- Secure a good exposure of cervix by two Sims’ speculums.
- Carry out a careful evaluation of the extent of the tear.
- Repair cervix with No. 1 chromic catgut under local anaesthesia (lignocaine HCL 1%) and achieve haemostasis. Then give antibiotics (PO amoxicillin/ clavulanate 625mg BD for 5 days) and PO paracetamol 1g 8 hourly for 3 days.
- NB: General anaesthesia may be required if upper limit of tear is not defined or laparotomy is further required.
Vaginal Tear
The following are important for vaginal tear:
- Examine in lithotomy position.
- Carry ligation of bleeders and repair of tears and laceration with No. 1 chromic catgut under local anaesthesia (lignocaine HCL 1%).
- Carry out evacuation of haematomata. Then give antibiotics (PO amoxicillin/ clavulanate 625mg BD for 5 days) and PO paracetamol 1g 8 hourly for 3 days.
Vulvoperineal Tear
Proper management of episiotomy:
- Define upper end.
- Stitch vaginal epithelium with continuous Chromic catgut No. 1 suture under local anaesthesia (lignocaine HCL 1%):
- Stitch muscle layer with the same interrupted stitch.
- Stitch skin with interrupted catgut.
- Repair all other tears.
- Then give antibiotics (PO amoxicillin/clavulanate 625mg BD for 5 days) and PO paracetamol 1g 8 hourly for 3 days.
If disseminated intravascular coagulopathy (DIC) develops:
- Administer fresh blood.
- Administer fresh frozen plasma.
- Carry out surgery as appropriate.
RUPTURED UTERUS
- Carry out laparotomy and then:
- Repair of the tear, or
- Hysterectomy.
- Give broad spectrum antibiotics ceftriaxone 1g OD for 3 days and analgesics morphine 10mg IM 4 hourly for 24 hours.