| 1 |
Apply
antiseptic solution to the vagina and cervix. |
| 2 |
Provide
emotional support and encouragement. Anaesthesia is
not required
for most cervical tears. |
| 3 |
Ask
an assistant to massage the uterus and provide fundal
pressure. |
| 4 |
Gently
grasp the cervix with ring or sponge forceps. Apply
the forceps on both sides of the tear and gently pull
in various directions to see the entire cervix. There
may be several tears. |
| 5 |
Close
the cervical tears with continuous 0 chromic non absorbable
(or polyglycolic) suture starting at the apex (upper
edge of tear), which is often the source of bleeding
(Figure 12.15). If a long section of the rim of
the cervix is tattered, under-run it with continuous 0 chromic non absorbable
(or polyglycolic) suture. |
| 6 |
If
the apex is difficult to reach and ligate, it may be
possible to grasp it with artery or ring forceps. Leave
the forceps in place for 4 hours. Do not persist in
attempts to ligate the bleeding points as such attempts
may increase the bleeding. Then after 4 hours, open
the forceps partially but do not remove. |
| 7 |
After
another 4 hours, if the bleeding has not recurred, remove
the forceps completely. |
