Soft birth trauma is observed much more often than pathological bleeding from the birth canal, although the trauma itself is the cause of these bleeding relatively rarely. Only rupture of varicose nodes, large venous and arterial vessels (anastomoses and individual branches) leads to bleeding that requires urgent surgical intervention. Finding out the cause of bleeding from the genital tract during childbirth or the early postpartum period, it is necessary first of all to exclude the trauma of the birth canal. Rupture of the uterus can cause a serious condition of women in childbirth and puerperas (shock, bleeding, infection).
Rupture of varicose nodes of the perineum and vagina
Despite the relative rarity of pronounced varicose nodes in the vulva and vagina, this pathology in violation of the integrity of the enlarged venous plexuses can cause severe bleeding. Varicose nodes of the perineum and vagina are recognized before the onset of labor, they are more often observed in multiparous. The expansion of venous vessels is often symmetrical on both the labia minora and labia minora. In a patient who is in an upright position, it resembles a tumor-like formation that completely closes the entrance to the vagina. Blood filling the vasculature of the vulva is easily squeezed out when the labia are compressed by the rollers or palmar surfaces of the hands. After the cessation of compression, the blood vessels are again filled with blood . In no patient did we observe the formation of trophic ulcers in the vulva and spontaneous rupture of varicose nodes with subsequent bleeding. With the right preventive measures, it is possible to reduce the development of varicose veins of this area during pregnancy and to almost completely eliminate the rupture of varicose nodes in childbirth. To this end , a strip of 4-6 cm wide is attached to the usual belt (abdomen), which is recommended to be worn with beerep , with one end to the front and the other to the back surface. The middle part of the strip is sewn from soft fabric (flannel), and the end ones are made of braided rubber mite, used for belts (bellies). Put on the belt in a prone position and in the same position fasten the end on the front surface of the belt.
In childbirth in the presence of varicose veins of the vulva, the most dangerous moments when a vascular injury occurs are the end of the second period of childbirth, the moment of cutting and eruption of the head. To prevent overflow of varicose nodes with blood during attempts, continuous (during the attempt) compression of the labia majora with palms or strips of matter is necessary, which are laid in the same way as described above.
When there is a risk of rupture of the tissues of the labia, a perineotomy is performed (with episiotomy , varicose nodes can be cut), which eliminates the obstacle to the passage of the fetal head. The rupture of the varicose nodes of the vulva is always accompanied by significant bleeding immediately after the birth of the fetus. Treatment for these conditions should include immediate ligation of the broken vessels. In the presence of a large network of varicose- dilated vessels, flashing them blindly can lead to the formation of an extensive hematoma of the labia majora with its spread to the vagina and perineum. Therefore, it is necessary to strive to separate the torn ends of the vessels (this is not always possible) and dress them with catgut. Stitching of varicose nodes blindly through the thickness of the spongy vascular tissue, as a rule, leads to disruption of the integrity of varicose nodes and the formation of an extensive hematoma. In these cases, the wound has to be wide open, a conglomerate of nodes is sifted out and repeatedly stitched in the transverse direction with respect to the length of the large lip. After this, a pressure dressing is applied for 24 hours. If the operation is performed by an inexperienced doctor, it may be ineffective and lead to severe anemia of the patient.
Rupture of the cavernous bodies of the clitoris
The rupture of the cavernous bodies of the clitoris is much more common than the varicose nodes of the vulva. If the rupture of the varicose nodes of the shameless lips is usually observed in multiparous women, then the rupture of the cavernous bodies of the clitoris usually occurs in the primiparous during spontaneous delivery, operative delivery (forceps, fetus extraction, fruit- destroying operations) or a violation of the methodology for managing the second stage of labor ( cutting and teething fetus).
Violation of the integrity of the cavernous bodies of the clitoris is always accompanied by bleeding, the intensity of which usually depends on the degree of damage to the cavernous bodies.
We had to observe the most severe cases of anemia due to the late recognition of the cavernous rupture or the ineffective stop of bleeding.
It is not difficult to establish the presence of bleeding from the cavernous bodies of the clitoris. When breeding the labia and displacement upward of the foreskin of the clitoris, the latter is completely exposed. Typically, clitoris tears are localized on its posterior wall and are in a longitudinal or transverse position with respect to the clitoris length . Rupture of the cavernous bodies can be on one or both sides.
Bleeding from cavernous bodies occurs in a continuous small stream. When reducing the lower extremities, it sometimes stops for a while due to thrombosis , and then starts again.
Stopping bleeding does not present technical difficulties. It is necessary to stitch, and then dress with catgut completely one of the cavernous bodies, closer to its base. You can not pierce the cavernous body, which was not damaged during childbirth.