MCPC - Repair of cervical tears - Health Education To Villages


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 Top of page		Clinical principles Rapid initial assessment Talking with women and their families Emotional and psychological support Emergencies 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 Symptoms Shock 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 Procedures Paracervical block Pudendal block Local anaesthesia for caesaran section Spinal (subarachnoid) anaesthesia Ketamine External version Induction and augmentation of labour Vacuum extraction Forceps delivery Caesarean section Symphysontomy Craniotomy and craniocentesis Dilatation and curettage Manual vacuum aspiration Culdocentesis and colpotomy Episiotomy 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 Appendix Essential drugs for managing complications in pregnancy and childbirth Index