Managing Complications in Pregnancy and Childbirth: - IAWG

REPAIR OF CERVICAL TEARS P-81• Review general care principles (page C-17) and apply antisepticsolution to the vagina and cervix (page C-22).• Provide emotional support and encouragement. Anaesthesia is notrequired for most cervical tears. For tears that are high andextensive, give pethidine and diazepam IV slowly (do not mix in thesame syringe) or use ketamine (page P-13).• Ask an assistant to massage the uterus and provide fundalpressure.• Gently grasp the cervix with ring or sponge forceps. Apply theforceps on both sides of the tear and gently pull in variousdirections to see the entire cervix. There may be several tears.• Close the cervical tears with continuous 0 chromic catgut (orpolyglycolic) suture starting at the apex (upper edge of tear), whichis often the source of bleeding (Fig P-45).• If a long section of the rim of the cervix is tattered, under-run itwith continuous 0 chromic catgut (or polyglycolic) suture.• If the apex is difficult to reach and ligate, it may be possible tograsp it with artery or ring forceps. Leave the forceps in place for 4hours. Do not persist in attempts to ligate the bleeding points assuch attempts may increase the bleeding. Then:- After 4 hours, open the forceps partially but do not remove;- After another 4 hours, remove the forceps completely.A laparotomy may be required to repair a cervical tear that has extendeddeep beyond the vaginal vault.FIGURE P-45Repairof acervical tear