Lacerations Small lacerations or tears of the birth canal are common and may be considered a normal consequence of childbearing.

Large lacerations, however, can cause complications. They occur most often: With difficult or precipitate births In primigravidas With the birth of large infant (>9lb) With the use of lithotomy position and instruments

Three Types of Lacerations Cervical Lacerations - Usually found on the sides of the cervix, near the branches of the uterine artery. - Gushing of blood from the vagina happened if the artery is torn. - Bleeding ordinarily occurs immediately after delivery of the placenta. Therapeutic Management Be certain that a physician or nurse-midwife has adequate space to work, adequate sponges, and suture supplies, and a good light source. Maintain an air of calm and, if possible, stand beside the woman, at the head of the table. Assure her about her babys condition and inform her about the need to stay in the birthing room a little longer than expected while the physician or nurse-midwife places additional sutures. If laceration difficult to repair, regional anesthetic is given.

Vaginal Lacerations - Rare and easier to assess than cervical lacerations because they are easier to view. Occurs in the vagina. Therapeutic Management Vagina may be packed to maintain pressure on the suture line after repair. Indwelling catheter may be placed at the same time, because the packing causes pressure on the urethra and can interfere with voiding. If packing is inserted, document in a womans nursing NCP( time, placement).

Perineal Lacerations - Usually occurs when woman is placed in a lithotomy position for birth, because this position increases tension on the perineum. Perineal lacerations classification by four categories, depending on the extent and depth of the tissue involved.

Therapeutic Management Make certain that the degree of the laceration is documented, because women with fourth-degree lacerations need extra precautions to avoid having repair sutures loosened or infected. A diet high in fluid and a stool softener may be prescribed for the first week after birth to prevent constipation and hard stools, which could break the sutures.

Degree of Lacerations

Classification
First degree

Description of involvement
Vaginal mucous membrane and skin of the perineum to the fourchette. Vagina, perineal skin, fascia, levator ani muscle, and perineal body. Entire perineum, extending to reach the external sphincter of the rectum. Entire perineum, rectal sphincter, and some of the mucous membrane of the rectum.

Second degree

Third degree

Fourth degree

Nursing Responsibilities Any woman who has a third or fourth-degree laceration should not have an enema or rectal suppositories prescribed or have her temperature taken rectally, because the hard tips of equipment could open sutures near to or including those of the rectal sphincter. Be sure that nurses aides are informed of this, so that they understand these measures.