Cervical Lacerations in Labor & Delivery: Episode # 117

True Birth

Cervical lacerations are cuts or tears that happen to the cervix during labor and delivery. These types of laceratsion are different from the typical 1st and 2nd degree lacerations that occur during labor and delivery normally. Generally they tend to have more blood flow and can be responsible for more blood loss. They also may have an effect in a subsequent pregnancy and labor.

Today’s episode of True Birth is all about cervical lacerations.

A cervical laceration is a cut or tear on the cervix that can happen during delivery. Despite its intimidating name, it’s certainly treatable, and we’re here to explain some helpful information that will let you know what you might be dealing with.

The cervix almost always tears a little during labor, but if the tear reaches the blood vessels in the cervix, it’s called a laceration, and a patient can have significant hemorrhaging.

Previously, the protocol included a check of the cervical angles (3 o'clock and 9 o'clock) in every vaginal delivery. Still, nowadays, a doctor will usually only examine the cervical angles if there’s a complicated delivery or more bleeding than expected. It’s unlikely to be coming from the uterus, and the placenta is already out.

If there’s a significant cervical laceration, it should be sutured - which is usually done with dissolvable stitches. Making sure the cervix is intact after delivery is essential because a cervical laceration that doesn’t heal well can lead to the issue of cervical insufficiency - which can be a cause of miscarriage in future pregnancies.

Recognizing cervical lacerations is the most significant factor in repairing them. And, if anyone has carried pregnancies to term and then begins to lose any, a thorough exam should be carried out to look for possible cervical insufficiency from previously undetected lacerations.

Previous use of a vacuum, forceps or even a history of precipitous (rapid) labor could increase the likelihood of having an issue with the shape of the cervical opening and therefore increase the chances of cervical insufficiency. Dr. Abdelhak proposes the theory that precipitous delivery is likely a mild form of cervical insufficiency.

Dr. Abdelhak also shares a few stories about times when using a cerclage (such as an abdominal or cervical cerclage) led to more success in carrying pregnancies to full term.

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