•    Perineal tears and lacerations

•    Vaginal tears

•    Cervical tears

•    Para-vaginal & VuIval hematoma

•    Pelvic or Broad ligament hematoma

•    Uterine rupture

Management of Genital Tract Tears

-  Inspect cervix, vagina and perineum

-  Repair tears that are:

o  Bleeding

o  More than first degree

o  Away from urethra

-  Place catheter if necessary All the while:

-            Transfuse blood as needed

-            Consider concurrent diagnoses if bleeding still heavy

Perineal Tear

-            Should be repaired immediately

-            Define the limits properly

-            The suture used is catgut or polydioxanone(PDS) - VICRYL

-            As accurate approximation possible should be done

-            Vaginal tear is repaired first

-            In complete perineal tear, repair rectal mucosa first followed by anal sphincter, vaginal mucosa, perineal body and finally skin

-            We need GA for 3rd and 4th degree perineal tears

-            Give antibiotics

-            The bowels are not encouraged to act for a few days

-            Thus a low residual diet is started from 2nd day onwards

Vaginal tears

-            Vaginal lacerations are more common in upper and lower thirds

-            They bleed profusely, so should be inspected and properly sutured

-            A good light source is necessary for proper visibility

-            Packing maybe done and removed after 6-8 hours

Cervical tears

o   Cervical tear is the commonest cause of traumatic PPH

o   Left lateral tear is the commonest.

o   A very good light source is needed for diagnosis and a successful repair

o   Proper assistance should be there

o   Repair is done under G.A.

o   Ant and post margins of torn cervix are grasped by sponge holding forceps. Apex is identified and 1st mattress suture is applied just above the apex using catgut.

o   Bleeding stops and rest of the tear is repaired by similar mattress sutures.