Postpartum Complications: Lacerations

Question 1

Large lacerations can be a source of

Answer 1

Infection or hemorrhage

Question 2

usually found at the sides of the cervix, near the branches of the uterine arteries

Answer 2

Cervical lacerations

Question 3

Therapeutic Management for Cervical lacerations

Answer 3

1. Usually requires suturing
2. Try to maintain an air or calm and if possible, stand beside the patient at the head of the table

Question 4

If the patient is worried about the condition of the baby, what would be the next course of action?

Answer 4

Give assurance to the patient about the condition of the baby

Question 5

If the cervical laceration appears to be extensive or difficult to repair

Answer 5

Administer regional anesthetic - to relax the uterine muscles and to prevent pain

Question 6

it is easier to locate and assess than cervical lacerations because they are generally easier to view

Answer 6

Vaginal lacerations

Question 7

Therapeutic Management for Vaginal lacerations

Answer 7

1. Balloon tamponade similar to uterine hemorrhage if suturing does not achieve hemostasis
2. Vagina may be packed to maintain pressure on the suture line
3. An indwelling urinary catheter (Foley catheter) may be placed after repair
4. Be certain to document when and where vaginal packing was placed in order to be certain to remove it after 24hrs to prevent infection

Question 8

Vaginal tissue is friable, making vaginal lacerations

A. Easy to suture
B. Difficult to suture

Answer 8

B. Difficult to suture

Question 9

It is more apt to occur when a patient is placed in a lithotomy position for birth rather than a supine position

Answer 9

Perineal lacerations

Question 10

During perineal lacerations, what area does supine position increase tension

Answer 10

Perineum

Lithotomy position increases tension on the perineum

Question 11

Four categories of Perineal Lacerations

Answer 11

First degree
Second degree
Third degree
Fourth degree

Question 12

Four categories of Perineal lacerations

Vaginal mucous membrane and skin of the perineum to the fourchette

Answer 12

First degree perineal laceration

Question 13

Four categories of Perineal lacerations

Vagina, perineal skin, fascia, levator ani muscle, and perineal body

Answer 13

Second degree perineal laceration

Question 14

Four categories of Perineal lacerations

Entire perineum, extending to reach the external sphincter of the rectum

Answer 14

Third degree perineal laceration

Question 15

Four categories of Perineal lacerations

Entire perineum, rectal sphincter, and some of the mucous membrane of the rectum

Answer 15

Fourth degree perineal laceration

Question 16

Therapeutic Management for Perineal lacerations

Answer 16

1. Sutured and treated the same way as an episiotomy repair
2. make certain the degree of laceration is documented
3. A diet high in fluid and a stool softener may be prescribed

Question 17

Fourth degree perineal lacerations need extra precaution to avoid what conditions

Answer 17

To avoid having sutures loosened or infected

Question 18

Patients with third or fourth degree perineal lacerations should not

Answer 18

1. Not have enema or a rectal suppository prescribed
2. Have their temperatures taken rectally

Question 19

Fourth degree perineal lacerations can lead to what 3 conditions

Answer 19

1. Long-term dyspareunia
2. Rectal incontinence
3. Sexual dissatisfaction