Tears of the birth canal

 

  • Can be tear of perineum, vagina, vulva or cervix
  • Common after birth —  always check carefully for tears, especially if heavy blood loss
  • Tears more likely to happen if quick birth or large baby
  • If bright blood loss, placenta delivered and uterus is firm and well contracted
    • Look at vaginal area for tear
    • If heavy bleeding ​but can't see bleeding tear — suspect cervical tear

Types of tears

Table 3.2   Tears of the birth canal

Figure 3.21   

 

Figure 3.22   

 

Figure 3.23   

 

Figure 3.24   

 

Do not

Do not suture tear or episiotomy unless trained

Check

  • Woman often very sore and embarrassed about this examination — be gentle, careful, sensitive and reassure woman
  • Offer nitrous oxide,​ if available — for pain relief and to help her relax
  • Position woman lying down with bottom at edge of bed, knees bent up and feet supported
  • Use good light — positioned properly
  • Put on sterile gloves
  • Mop up blood in vagina entrance with sterile gauze swabs
  • Check perineum, vulva, urethra, labia and clitoris
    • Separate labia and look at vaginal opening
    • Wrap sterile gauze around fingers and use to gently separate the walls of vagina
    • If tear/bleeding high up in vagina or hard to see — may need sterile speculum exam
  • Check for 3rd or 4th degree tear
    • Put gloved index finger into rectum and feel for anal sphincter between thumb on outside and finger on inside — should feel circular ridge of muscle around anus
    • Check for small fibres that may indicate partial 3rd degree tear ​
    • Change gloves after rectal exam
  • Follow each tear to end to see where it stops

Do

  • Repairing tear properly will control bleeding — start as soon as possible

Table 3.3  

If tear bleeding

  • Apply pressure with sterile pad for 5–10 minutes
    • If bleeding continues — ask helper to apply pressure
    • Recheck for bleeding after another 10 minutes pressure
    • If still bleeding — medical consult — may suggest putting in large stitches at bleeding point, clamping bleeding point and/or packing vagina — record what and how much/many used
  • Keep applying pressure for as long as needed — weigh pads to work out blood loss — 1g increase = 1ml loss
    • If bleeding still continues — put in IV cannula, largest possible AND start normal saline 1L at 125mL/hr
  • Medical consult — are antibiotics ​needed
  • If woman unable to pass urine — put in indwelling urinary catheter
  • Reassure woman and family
  • Encourage woman to hold and breastfeed baby, unless feeling very unwell
  • Do routine observations including checking uterus is firmly contracted — every 30 minutes until evacuation