POSTPARTAL COMPLICATION: Laceration

I. Definition
- is an open wound wherein the edges are often jagged and tissues are torn apart




II. Etiology
- with difficult/ precipitate births
- in primigravidas
- with the birth of a large infant (more than 9 lb)
- with the use of a lithotomy position
- episiotomy
- use of forceps/ vacuum extraction for delivery



III. Types

A. Cervical Lacerations
- usually found on the sides of the cervix, near the branches of the uterine artery
- occurs immediately after the delivery of the placenta

B. Vaginal Lacerations
- rare
- easier to assess

C. Perineal Lacerations
- occur when a woman is placed in a lithotomy position


Four Categories

*First degree - vaginal mucous membrane & skin of the perineum to the fourchette
*Second degree - vagina, perineal skin, fascia, levator ani muscle & perineal body
*Third degree - entire perineum & reaches the external sphincter of the rectum
*Fourth degree - entire perineum & some of the mucous membrane of the rectum



IV. Signs/Symptoms
- fundus is firm on palpation yet bleeding is heavy, bright red, and continues in a steady trickle or flow
- pain may be constant
- bruising may be apparent






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Sources:

Kozier, Erbs., 8th Ed. Fundamentals of Nursing. Volume 2 p.904

Adele Pillitteri, 5th Ed. Maternal & Child Health Nursing: Care of the Childbearing & Childrearing Family. Volume 1 pages 595, 605, 614, 661- 662

Zabriskie, 10th Ed. Obstetrics for Nurses. p.278

Klossner, Hatfield, Introductory Maternity & Pediatric Nursing by Klossner & Hatfield p.456, 459