Stitches and recovery from vaginal tearing

Vaginal tearing is a common situation during labor and vaginal birth, especially in pregnant women who give birth to their first child. This tear stretches the vagina, making it easier for the baby to cross the birth line.

Vaginal tearing,often accompanied by a torn mesority, is a condition that occurs after a woman is born with a biological incision, or a birth thanks to supporting procedures such as forceps, suction… Other factors that cause the vagina to tear include:

• Overweight pregnant women;
• Rapid labor;
• Prolonged labor period;
• The buttocks with the head facing upwards create a lot of pressure;
• The mother gave birth for the first time, so the vaginal muscle tissue has not adapted and stretched wide enough.

Vaginal tearing if not detected and handled in a timely manner risks causing patients to suffer from severe, stun and sometimes life-threatening blood loss. Symptoms of vaginal bleeding may be more or less depending on the degree of damage. The location of the torn vagina is also not fixed, sometimes appearing in the right, left or back of the vagina. Therefore, doctors need to use specialized equipment to reveal each part of the vagina, including the underside, right or left side, top and the same item. As a result, it is possible to assess and categorise the injury correctly, thereby deciding the right direction of action.

Based on the degree of damage, vaginal tearing is classified into 3 types as follows:

• Low vaginal tearing: This is a form of tearing in 1/3 of the vagina, often accompanied by larye larye tearing and peroral tearing (area in the middle of the vagina and rectum);
• Vaginal tearing in the middle: This condition is less common, although the lesion is more severe and bleeding, but it is difficult to detect if it is not clearly manifested;
• High vaginal tearing: Is a type of tear in 1/3 of the vagina, often accompanied by tearing of the same item, but is generally rare.

Vaginal tearing to any extent causes the patient to feel very painful, sometimes it is difficult to sit upright on the back. If the pregnant woman only has a slight vaginal tear, the unpleasant symptoms will last from 1 to 2 weeks. During this time, actions that put pressure on the lower body such as going to the toilet, coughing or sneezing … also causes pain. By the second week the tear will gradually re-dissolve and the sutures dissolve, but muscle strength and nerves still need a few more weeks to fully recover..

In case the patient encounters a more severe vaginal tear, the recovery process will take longer. Aches and pains can last from weeks to months. If the tear is too severe, there is also a risk of pelvic dysfunction,fall-off of the uterus , problems with excreting and sexual activity.

3.1. Implementer

Immediately after being diagnosed with vaginal damage, the team of doctors should prescribe vaginal rehabilitation immediately to avoid the loss of a lot of blood. The choice of the person who directly performed the procedure will depend on the degree of shallow or deep tearing, tearing outside, middle or in the vagina. Specifically:

• Shallow tearing and lying in 1/3 of the vagina: Experienced householder or obstetrician performing recovery;
• Remaining cases (torn 1/3 on/ middle / deep): Experienced mid-headmistance or obstetrician and gynecologist.

3.2. media

Medical kits necessary for vaginal tear recovery procedures include:

• Vaginal valves;
• CTC heart-shaped clamps, disinfection and needle clamps;
• A straight, sharp scissors;
• Tweezers;
• Antiseptic solution, polydine or povidine antiseptic;
• Only vicryl no. 1;
• One syringe 10 ml.

3.3. Sick people

Before the vaginal rehabilitation procedure, the doctor will assess the entire condition of the female patient by asking and examining the medical record so as not to miss the information related to:

• Blood loss;
• Pulse beats;
• Blood pressure index;
• The degree of post-birth uterus contraction is usually, it is necessary to take drugs to stimulate the contraction of the uterus if it is not reached;
• Some diseases are associated with the function of hemulation, such as tinglet reduction,prolonged APTT, decreased blood fibrinogen levels, …;
• Allergies to anesthetics, analgesic or antibiotics.

The procedure for stitching and recovering from vaginal tearing due to an incision of the mesority during normal birth or using a supporting instrument is as follows:

• The assistant holds the vaginal express valve while the obstetrician or nurse has experience in vaginal, biological and urinary disinfection;
• Local anesthesia with Lidocain 2% 2 ml + 3 ml of distilled water to relieve pain, but if the pregnant woman has been given an anesthetic to relieve pain during and after birth there is no need to apply additional doses;
• Stitch the vaginal tear from top to bottom;
• If the tear is shallow, stitch 1 layer of squeezing with vicryl or other types of self-dissolving only; if the tear is deep and complex, it must be stitched in several layers, the nose is separated by self-dissolving only;
• After the stitches are completed, vaginal disinfection is required;
• Check if there is stitching in the rectum by put 1 finger in the anus, if there is a need to cut the index and stitch it up;
• The last step is disinfection.

It should be noted that during the recovery of vaginal tearing, theupper layer must overlap the lower layer to avoid hematoma. Stitching the lower layer requires just close to the bottom of the lesion, which not only helps to prevent hematoma, but also avoids stitching into the rectum.

After the procedure, the patient should be monitored for the full condition, namely:

• Pulse, blood pressure and vaginal bleeding. If the blood continues to flow, it is necessary to check the stitches again;
• Manifestations of hematoma often cause the pregnant woman to be in the vaginal area, the – rectal area with a feeling of insertion and squeezing. Treat the hematoma by examining the vagina and cutting off only the hematoma, then stitching the entire bottom with a layered detached nose to avoid openings;
• Blood loss and red blood cell tests,hemoglobin, must transmit blood in case of necessity;
• Give antibiotics to the maternity within 5 days after stitching.

To limit the risk of vaginal tearing duringnormal birth, the maternity needs to adhere to the pushing pose as directed by the doctor during labor. In addition, before giving birth 4-6 weeks, pregnant mothers should refer to performing squat exercises to support women who are about to give birth and regularly massage the perineum every day for about 15 minutes with lubricants to help soften the tissues, making the birth muscles more flexible and stronger.