A Text-book of Diseases of Women

by Charles B. Penrose

Fig. 100.—Incomplete laceration of the cervix.

The appearance of a lacerated cervix varies with the time that has elapsed since the receipt of the injury. A few weeks or months after the occurrence the torn portions of the cervix will be found, by sight or touch, lying in more or less close apposition, the general conical shape of the cervix being unaltered. After the lapse of a longer period, however, the edges of the laceration become rounded, and a certain amount of eversion, or turning out, of the portions of the cervix takes place, so that the mucous membrane of the cervical canal becomes exposed. This eversion is always most pronounced in the bilateral laceration, and is especially striking when the tear has extended entirely through the cervix into the lateral vaginal fornices. In such cases the cervix assumes the shape of a split stalk of celery ([Fig. 101]). The cases of laceration with eversion of the lips are those in which the most marked symptoms are found. When eversion occurs, and the mucous membrane of the cervical canal is exposed, the shape and appearance of the cervix are very much altered from the normal. Before the true nature of this lesion had been pointed out by Emmet such a cervix was said to be ulcerated, the raw-looking surface, corresponding to the exposed, irritated, and inflamed mucous membrane of the cervical canal, having been mistaken for an ulcer. Even at the present day such a mistake is not infrequently made.

Fig. 101.-Bilateral laceration of the cervix with eversion. The dotted line shows the normal shape of the cervix.

Microscopical examination of such raw-looking surfaces shows that they are in no sense ulcers. “The surface is covered with a single layer of epithelium; the cells are smaller than those which line the normal cervical canal, and, being narrow and long, have a palisade-like arrangement; the thin layer of cells allows the subjacent vascular tissue to shine through, hence the redness of color. The surface is further thrown into numerous folds, producing glandular recesses and processes; these processes cause the granular appearance of the surface” (Hart and Barbour).

These red patches are larger than the surface of the everted mucous membrane of the cervical canal; they are continuous with, but extend beyond the limits of, this mucous membrane. It is said that this increase is occasioned by proliferation of the epithelium that lines the cervical glands.

As a substitute for the misleading term “ulceration,” applied to this condition, there have been proposed the terms “erosion,” “ectropion,” or “eversion” of the mucous membrane, and “catarrhal patch.”

A true ulcerated surface is sometimes found on a lacerated cervix as a result of excessive irritation, but such a condition is rare.

As the laceration occurs in the cervix before involution has begun, this process is impeded, so that a state of subinvolution of the cervix results, and the part remains hypertrophied or much larger than normal.