LACERATIONS/TEARS OF GENITAL TRACT

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.