A Text-book of Diseases of Women

by Charles B. Penrose

CHAPTER XII.

LACERATION OF THE CERVIX UTERI.

Laceration of the neck of the uterus is of very frequent occurrence. It is said that nearly every woman suffers with a laceration of greater or less extent at her first labor. The majority of such lacerations, however, undoubtedly heal during the puerperium and give no subsequent trouble. The lacerations that concern the gynecologist are those that persist, remaining ununited after the woman leaves her bed. The description of the injured parts and the treatment therefor will be applicable to such old cases of laceration. It is true that some gynecologists have advised immediate examination and the primary operation for repair in case of laceration of the cervix, as in case of injury to the perineum; but such a course has at present but little endorsement. It is difficult to obtain a satisfactory examination under such circumstances. A digital examination alone, unless the sense of touch be very acute, would often fail to detect the lesion in the soft cervical tissue. The woman is exposed to the danger of infection of the upper genital tract from the manipulations of the examination and the operation, and such exposure may be unnecessary, because there is no doubt that many lacerations of the cervix unite of themselves.

It has been found necessary to perform the operation immediately after labor on account of severe hemorrhage from the lacerated wound.

Laceration of the cervix may take place in any direction, and the injury is described according to the direction and number of the tears. A lateral laceration takes place on either side of the cervix. A bilateral laceration involves both sides ([Fig. 104], A). The left is the more usual lateral laceration ([Fig. 98]), and in case of a bilateral tear the injury on the left side is usually the more extensive. The stellate laceration ([Fig. 99]) occurs when three or more lacerations radiate from the cervical canal. The less common varieties of laceration seen by the gynecologist are through the anterior and through the posterior lip. It may be that such lacerations occur as often as the lateral lacerations, and that spontaneous repair more often occurs, so that they produce no subsequent trouble. The relations of the neck of the uterus are such that accurate apposition of the injured parts is more likely to occur in case of antero-posterior laceration than in the lateral form of the injury. In some cases there seems to be no doubt that the laceration has extended through the posterior lip of the cervix into the cellular tissue above the posterior vaginal fornix, and that spontaneous repair has taken place, leaving a dense band of scar-tissue to mark the site of the lesion.

Fig. 98.—Left lateral laceration of the cervix with erosion.

Fig. 99.—Stellate laceration of the cervix.

An incomplete laceration of the cervix is sometimes found. In this injury the tear has extended but part way through the wall of the cervix. The mucous membrane of the cervical canal and the muscular wall of the cervix are lacerated, but the injury does not involve the mucous membrane of the vaginal aspect, beyond, perhaps, a slight splitting of the external os ([Fig. 100]). The lesion is thus concealed, and separation of the portions of the cervix is prevented. The injury may be detected by introducing a sound in the cervical canal and placing a finger on the vaginal aspect of the cervix, when it will be found that at this spot the point of the sound and the finger are separated only by the thickness of the vaginal mucous membrane, and not by the normal thickness of the wall of the cervix.