According to our data, out of 10,000 puerperas, cervical tears were observed in 27.6% of primiparous and in 5.3% of multiparous. In multiparous, cervical ruptures are rarely observed, mainly if the fetus is large or surgical delivery is performed .
Rupture of the cervix, as a rule, occurs from the back of the head (in 78%) and less often from the front of the fetus. One-sided cervical ruptures were observed in 68.2% of the prostitutes , two-sided in 29.4%, multiple cervical ruptures and crises in 2.4% of the total number of identified ruptures. In multiparous spontaneous births, one-sided ruptures prevail.
Bleeding from the cervix, requiring urgent interventions, occurred in 3.6% of women in labor. In the rest, ruptures of the neck were revealed during routine examinations of the birth canal. In the group of women with bleeding from the birth canal, cervical trauma as a cause of bleeding takes a small proportion and amounts to 3-7%, according to various large obstetric hospitals.
Bleeding from the cervix arises, as a rule, from arterial branches. Blood with its bright red color differs from venous blood flowing from the vessels of the uterus. With cervical ruptures that extend to the tissues of the arch or lower segment of the uterus, bleeding can be from damaged large venous vessels, and then the blood in appearance does not differ from the flow from the uterus.
Diagnosis of bleeding with ruptures of the cervix but presents difficulties and is carried out by examining the cervix using mirrors. Neck capture fenestrated forceps and completely degrade the bottom. Consistently inspect its entire surface. If a rupture is detected (it is usually localized on the lateral surface of the cervix), it is necessary to carefully examine its upper border and, if possible, the lower section (segment) of the uterus above the rupture site. For this purpose, mirrors with lighting made of transparent plastic are successfully used. We always conduct a digital examination of the lower segment of the uterus and the area above the rupture of the inner surface of the cervix. This is necessary to recognize incomplete ruptures of the lower segment of the uterus, which may not extend to the tissues of the vaginal fornix.
After analyzing a large number of births that ended fatally as a result of acute anemia (data from obstetric hospitals in Ukraine), we identified cases when a deep rupture of the cervix was timely detected, stitches were sutured, and bleeding continued due to a rupture of uterine tissue above a visible rupture of the cervix.
Linear ruptures of the cervix can sometimes be accompanied by stratification, rupture or crushing of the muscles of the inner surface of the cervix. These lesions are easily detected when examining the inner surface of the neck. Bleeding from the cervix is stopped by imposing knotted catgut sutures transverse to the length of the neck rupture after preliminary excision of the neck tissue. As a result of refreshing the edges of the gap, the healing process of the neck by primary intention is significantly increased. Catgut or silk sutures are applied , and the first suture must be applied to the neck tissue at the upper rupture angle or even higher, within intact tissues. Silk sutures should be removed on the 8-9th day after birth.
Uterine ruptures, regardless of the size of the damage (complete, incomplete), are usually accompanied by bleeding, although the amount of blood loss is not always proportional to the degree of tissue damage. If arterial or venous vessels of large diameter rupture together with the uterine muscle, bleeding can be significant, even fatal. If vessels of small diameter that are within the muscle tissue rupture , they can be squeezed by a contracted uterus and bleeding in this case will be small.
With uterine ruptures, external bleeding (blood flows from the genitals) and internal bleeding are distinguished when the bleeding accumulates in the abdominal cavity (with a complete rupture), in the peritoneal and pelvic tissue (with an incomplete rupture). The absence of visible bleeding can lead to a gross error in assessing the patient’s condition and ultimately to her death due to an unrecognized rupture of the uterus.