Chapter: Obstetric and Gynecological Nursing : Abnormal Labour

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Lacerations

A tear is called laceration. The tear can occur in the vaginal wall or in the perineum or in the cervix.

Lacerations

 

A tear is called laceration. The tear can occur in the vaginal wall or in the perineum or in the cervix. Tears of the perineum are graded according to their severity. Other areas of trauma may be the cervix and extended tears of the vagina.

 

Causes

 

·        Not controlling the head at delivery

 

·        Precipitate labour

 

·        Big baby

 

·        Face to pubis and after coming head of breech

 

·        Instrumental delivery

 

·        Old scar tissue and face presentation

 

Type of perineal lacerations

 

First degree

 

Involves the vaginal mucous and the skin of the perineum.

 

Second degree

 

Involved the deeper layer of perineal muscle

 

 

Third degree

 

Also called complete tear is a perinea laceration passing through/ involves/ the anal sphincter lying open the birth canal.

 

First and second degree laceration can be repaired by nurses midwife but third degree or complete tear is repaired/ sutured/ by a doctor in hospital under anesthesia This type of tear is very serious and must be avoided. The repair must be watertight. The repair will be done with in 24 hours. Transfer patient to Hospital after the repair, the laceration care should be taken in order to avoid infection. The suture line must heal well. The patient is kept on low residue diet and the doctor usually order liquid paraffin to keep the stool soft. Stool should not be passed for 7-8 days. Vulva swabbing should be done each time patient passes urine and later stool

 

Prevention of Lacerations

 

·        Gain the woman’s co-operation

·        Get patient to delivery at the end of a contraction

·        Control head, keep it flexed, so small diameter is emerges.

·        Get mother to breath the head out

·        Delivery the shoulder in anterior- posterior diameter and lift up the posterior shoulder.

·        Perform episiotomy when the perineum is very tight

 

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