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Department of Reproductive Health and Research (RHR), World Health Organization

Managing Complications in Pregnancy and Childbirth

A guide for midwives and doctors 


Section 3 - Procedures

Repair of cervical tears

  • Review general care principles  and apply antiseptic solution to the vagina and cervix.

  • Provide emotional support and encouragement. Anaesthesia is not required for most cervical tears. For tears that are high and extensive, give pethidine and diazepam IV slowly(do not mix in the same syringe) or use ketamine.

  • Ask an assistant to massage the uterus and provide fundal pressure.

  • Gently grasp the cervix with ring or sponge forceps. Apply the forceps on both sides of the tear and gently pull in various directions to see the entire cervix. There may be several tears. 

  • Close the cervical tears with continuous 0 chromic catgut (or polyglycolic) suture starting at the apex (upper edge of tear), which is often the source of bleeding (Fig P-45).

  • If a long section of the rim of the cervix is tattered, under-run it with continuous 0 chromic catgut (or polyglycolic) suture. 

  • If the apex is difficult to reach and ligate, it may be possible to grasp it with artery or ring forceps. Leave the forceps in place for 4 hours. Do not persist in attempts to ligate the bleeding points as such attempts may increase the bleeding. Then:

- After 4 hours, open the forceps partially but do not remove;

- After another 4 hours, remove the forceps completely.

A laparotomy may be required to repair a cervical tear that has extended deep beyond the vaginal vault.


Figure P-45

 Repair of a cervical tear


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Clinical principles

Rapid initial assessment

Talking with women and their families

Emotional and psychological support


General care principles

Clinical use of blood, blood products and replacement fluids

Antibiotic therapy

Anaesthesia and analgesia

Operative care principles

Normal Labour and childbirth

Newborn care principles

Provider and community linkages



Vaginal bleeding in early pregnancy

Vaginal bleeding in later pregnancy and labour

Vaginal bleeding after childbirth

Headache, blurred vision, convulsions or loss of consciousness, elevated blood pressure

Unsatisfactory progress of Labour

Malpositions and malpresentations

Shoulder dystocia

Labour with an overdistended uterus

Labour with a scarred uterus

Fetal distress in Labour

Prolapsed cord

Fever during pregnancy and labour

Fever after childbirth

Abdominal pain in early pregnancy

Abdominal pain in later pregnancy and after childbirth

Difficulty in breathing

Loss of fetal movements

Prelabour rupture of membranes

Immediate newborn conditions or problems


Paracervical block

Pudendal block

Local anaesthesia for caesaran section

Spinal (subarachnoid) anaesthesia


External version

Induction and augmentation of labour

Vacuum extraction

Forceps delivery

Caesarean section


Craniotomy and craniocentesis

Dilatation and curettage

Manual vacuum aspiration

Culdocentesis and colpotomy


Manual removal of placenta

Repair of cervical tears

Repair of vaginal and perinetal tears

Correcting uterine inversion

Repair of ruptured uterus

Uterine and utero-ovarian artery ligation

Postpartum hysterectomy

Salpingectomy for ectopic pregnancuy



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