Damage to the genital tract may occur spontaneously or through manipulations used to deliver the baby.Lacerations often occur in the region overlying the ischial spines.This admonition includes myomectomy; uteroplasty for congenital abnormality; cornual or cervical ectopic resection; and perforation of the uterus during dilatation, curettage, biopsy, hysteroscopy, laparoscopy, or intrauterine contraceptive device placement.Vaginal sidewall laceration is also most commonly associated with operative vaginal delivery, but it may occur spontaneously, especially if a fetal hand presents with the head (compound presentation).Trauma may occur following very prolonged or vigorous labor, especially if the patient has relative or absolute cephalopelvic disproportion and the uterus has been stimulated with oxytocin or prostaglandins.An intraumbilical vein saline/oxytocin or saline/misoprostol injection may reduce the need for more invasive removal techniques.Very rarely, the cervix is purposefully incised at the 2- and/or 10-o'clock positions to facilitate delivery of an entrapped fetal head during a breech delivery (Duhrssen incision).The frequency of sidewall and cervical lacerations has probably decreased in recent years because of the reduction in the use of midpelvic forceps and, especially, midpelvic rotational procedures.Incisions in the poorly contractile lower segment heal well but are more reliant on suturing, vasospasm, and clotting for hemostasis.Spontaneous lacerations usually involve the posterior fourchette; however, trauma to the periurethral and clitoral region may occur and can be problematic.[8]
Cervical laceration is most commonly associated with forceps delivery, and the cervix should be inspected following all such deliveries.Any uterus that has undergone a procedure resulting in a total or thick partial disruption of the uterine wall should be considered at risk for rupture in a future pregnancy.The highest risk is probably associated with internal version and extraction of a second twin; however, uterine rupture may also occur secondary to external version.Finally, trauma may result secondary to attempts to remove a retained placenta manually or with instrumentation.Lacerations may occur during manipulations to resolve shoulder dystocia.