Relevancy. Female birth canal is significantly distended during labor. External genital organs, the perineum, vagina, and uterine cervix can sometimes rupture in pathological course of delivery; their rate is 20%. Sometimes the woman sustains life threatening injuries which lead to her death or long-term disability (uterine rupture, urogenital and enterogenital fistulas). Tears of the soft tissues of the birth canal occur in primiparous women, uterine ruptures - mainly in multiparous women. The rate of cervical ruptures is 6-15%, of perineal ruptures of III-IV degree is 3 in 10 thousand of deliveries, of uterine rupture - 1 in 10 thousand of deliveries.
General considerations. Labor traumatism (lacerations of birth canal soft tissues) occurs in case of contracted pelvis, fetal macrosomia, abnormal labor activity, late and improper obstetric care. Labor injuries can be spontaneous or forced, mechanical (overdistension of tissues), morphological (histochemi-cal abnormalities), mixed (mechanical and histochemical) and ruptures by location.
11.1. Vaginal and vulvar lacerations
Vulvar laceration is breach of integrity of vulvar soft tissues during fetal expulsion. Superficial lacerations are not accompanied by hemorrhage; deep fissures in the area of clitoris, urethra can be complicated by significant bleeding.
According to location of vulvar lacerations, there are:
► lacerations of labia minora;
► lacerations in the area of vaginal vestibule;
► lacerations in the area of clitoris;
► lacerations of labia majora.
Diagnosis is based on visual examination of external genital organs.
Treatment. If there are deep ruptures and hemorrhage, the integrity of damaged tissues is restored. The surgical area is swabbed with antiseptic solution. Ruptures are sutured under local infiltration or epidural anesthesia (if a cathe-