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Birth canal injury
1. The document discusses various injuries that can occur to the birth canal during childbirth, including classifications, causes, symptoms, diagnosis, and management. 2. Injuries include perineal tears, cervical and vaginal lacerations, hematomas, and complete uterine rupture. Causes may include obstructed labor, instrumentation, or congenital factors. 3. Diagnosis involves investigations like ultrasound and symptoms like pain, bleeding, and shock. Management depends on the type of injury but may include suturing lacerations, draining hematomas, or laparotomy for severe injuries like uterine rupture.
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Birth canal injury
- 1. BIRTH CANAL INJURY Devender MaulanaAzad Medical College
- 2. Objectives of thisSession…. 1. Anatomy of birth canal 2. Classification of injuries 3. Causes, Diagnosis & Management of injuries
- 3. Birth Canal -Definition Genital tract through which delivery of the fetus occurs Uterus Cervix Vagina Vulva (& Perineum)
- 4. Classification of Injury •Depending on anatomical structure involved • Depending on type of injury • Example - Laceration, Hematoma, Rupture
- 5. Anatomical Classification • Injuriesto Bony parts • Symphysis pubis • Sacro-coccygeal joint • Sacro-Illiac joint • Injuries to Soft tissue • Vulva • Perineal tears • Laceration to Vagina / Cervix • Rupture of Uterus
- 6. Causes of Injury 1.Incomplete dilation of cervix 2. Instrumentation (Wrong application) 3. Precipitate labor 4. Protracted labor due to borderline CPD 5. Obstructed labor 6. Iatrogenic
- 7. Perineal Injury • Deliberateincision on perineum (Episiotomy) • Perineal tears • Trauma • Bull gore injury • Sexual assault
- 8. Cervical Laceration /Tear • Congenital elongated cervix • Forced dilatation of cervix • Traumatic • During delivery of fetus • Due to instrumentation
- 9.
- 10. Medio-lateral - Episotomy •Skin • Subcutaneous tissue • Fascia • Superficial and deep transverse perineal muscles • Transverse perineal branches of pudendal vessels & nerve • Bulbospongiosus • Posterior vaginal wall
- 11. Type • Medial • Medio– lateral • Lateral
- 12. Midline Perineum Anatomy •Medial • Vaginal mucosa • Perineal body • Superficial transverse perineal muscles • External anal sphincter • Internal anal sphincter • Anal wall
- 13. First Degree -Perineal tear
- 14. Second Degree -Perineal tear
- 15. Third Degree -Perineal tear
- 16.
- 17.
- 18.
- 19. Rupture Uterus • Dueto Obstruction in labor • Cephalo-pelvic disproportion • Contracted pelvis • Malpresentation • Fetal malformation • Scarred uterus • Due to Manipulation / Instrumentation • Mis-use of oxytocin
- 22. Bandl’s Ring (Obstruction) •Upper segment contracts & retracts • Upper segment becomes thick • Lower segment Stretches • Lower segment thinning
- 23. Symptoms • Pain • Syncopalattack • Bleeding • Pallor • Tachypnea • Tachycardia • Hypotension • Shock • Signs of obstructed labor • Loss of uterine contour Signs
- 24. Investigations • Hb, PCV,Platelets • Blood group & type • Blood urea • Serum creatinine • Serum Electrolytes • Coagulation profile • Ultrasonography – in cases of doubt
- 25. Informed written consent •Status of the patient • Convey diagnosis & management options • Prognosis • Written consent
- 30.
- 31. a) 24 hourslater b) 48 hours later c) 36 hours later d) Immediately Perineal tears should be repaired
- 32.
- 33. a) Evacuation b) Wait& Observe c) Cold compress d) marsupialisation Most suitable method of treatment of 4 inches size episiotomy haematoma is by
- 34.
- 35. a) Immediately b) 2weeks c) After 6 weeks d) After 12 weeks In a patient with third degree perineal tear, presenting after 72 hr, repair should be done
- 36. d) After 12weeks
- 37. a) Anal sphincter b)Perineal body c) Perineal muscles d) Rectal mucosa A woman delivers a 4 kg baby with a midline episiotomy and suffers a third degree tear. Inspection shows which of the following structures is intact
- 38.
- 39. a) Vaginal mucosa b)Urethral mucosa c) Levator ani muscles d) Anal sphincter IIIrd degree perineal tear is involvement of
- 40.
- 41. a) analgesics b) Icecompress c) Incision and drainage d) Angiographic embolization Which of the following is the best treatment for vulvar hematomas that are extremely painful, but stable in size
- 42. c) Incision anddrainage
- 43. Management • Basic lifesupport – A B C D • Correction of shock • Treat anemia & coagulation profile • Treat the cause • Vaginal or cervical Laceration – suture in OT • Paravaginal hematoma – Drain & repair • Supra-levator hematoma or Rupture - Laparotomy
Editor's Notes
- #29 IIA: Internal Iliac Artery; LST: Lumbosacral Trunk; URT: Ureter; EIA: External Iliac Artery; EIV: External Iliac Vein; CT1: Common Trunk 1; UNA: Unnamed Artery; LSA: Lateral Sacral Artery; SGA: Superior Gluteal Artery; CT2: Common Trunk 2; IPA: Internal Pudendal Artery; MRA: Middle Rectal Artery; IVA: Inferior Vesicle Artery; SVA: Superior Vesicle Artery; MUL: Medial Umbilical Ligament; AOA: Abnormal Obturator Artery; AOV: Abnormal Obturator Vein; IEA: Inferior Epigastric Artery; IEV: Inferior Epigastric Vein; UUB: Unusual Branches; UB: Urinary Bladder.