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Abstract: The patient developed vaginitis in late pregnancy but was not treated as prescribed. The inflammatory infection caused the vaginal wall tissue to become loose and brittle, resulting in vaginal edema and a vaginal laceration of degree I during delivery. After timely treatment with sutures to stop the bleeding, the patient recovered well, the vaginal laceration was mildly painful, but there was no infection or bleeding, and the perineal edema subsided significantly and she was discharged successfully.
Basic information】Female, 36 years old
Type of disease】Vaginal laceration degree I
Hospital】Jiangbin Hospital of Guangxi Zhuang Autonomous Region
Date of consultation】December 2021
Treatment plan] Vaginal laceration suture + 50% magnesium sulfate solution wet and hot compress
【Treatment Period】5 days in hospital, 1 week later outpatient review
Results】Postpartum recovery was good, vaginal laceration was slightly painful, but there was no infection or blood oozing, perineal edema subsided significantly, and she was discharged successfully.
I. Initial consultation
The patient reported that her last menstrual period was on March 14, 2021 and her expected delivery date was December 21, 2021. She started to feel fetal movement at 20 weeks of pregnancy, and her labor and delivery went smoothly. The patient was advised to treat vaginitis, but she felt that the medication would affect the fetus, so she did not follow the medical advice. After sterilization, the gynecological examination was performed by the outpatient doctor. The vulva was red and swollen, and the vaginal discharge was tofu-like, the cervical canal was receding, and the uterine opening was 2cm.
Treatment
The patient was admitted to the hospital and was told that she was in labor and that although she was a senior primigravida, no indication for cesarean section was found after the relevant examination, so she could have a trial of vaginal delivery. The patient felt very fatigued during labor and had difficulty cooperating with the midwife, and the perineum was obviously edematous. After delivery, the doctor examined the patient’s vagina and found a vaginal laceration of degree I. The most obvious one was a 4 cm long and 2.5 cm deep laceration on the right side of the vaginal wall, and the vaginal laceration was sutured with absorbable sutures to close the vaginal laceration and the lateral incision wound. The patient was instructed to review outpatient after 1 week.
III. Treatment results
Since the patient’s perineal edema was obvious and the tissue in the vagina was brittle due to inflammation, it was easy to tear and bleed. Gauze rolls were given to compress the vagina after suturing, which had the effect of compressing the wound to reduce bleeding and avoiding vaginal hematoma after delivery. The gauze roll was taken out 1 day after delivery, and the vaginal suture wound was examined for no bleeding and no hematoma in the vagina, which indicated that the treatment was effective, and the patient was given 50% magnesium sulfate solution with wet and hot compresses due to the obvious perineal edema.
IV. Notes
The patient recovered quickly after delivery and was discharged from the hospital smoothly, which made the doctor feel very happy. However, patients should pay attention to the following points after discharge.
1.After delivery, pay attention to the observation of the malodorous dew, because the patient has obvious vaginitis before delivery, and after delivery, the malodorous dew appears to have increased bleeding and odor, etc. It is necessary to go to the hospital for follow-up to exclude puerperal infection.
2.Strengthen nutrition, pay attention to personal hygiene after delivery, change sanitary napkins and underwear diligently to prevent vaginal wound infection, and review wound healing in 1 week at the outpatient clinic.
3. As the vaginal wound is obvious, it is recommended not to have sex too early, avoid strenuous exercise and take more rest to promote the healing of vaginal wound.
4. It is recommended that postpartum examination should be performed 42 days after delivery, especially pelvic floor function assessment, and pelvic floor rehabilitation should be performed as much as possible for patients with pelvic floor dysfunction.
V. Personal insight
There are many reasons for vaginal laceration during labor, such as advanced age, poor vaginal elasticity, and the use of fetal head aspiration to assist labor in difficult labor. Vaginitis infection can cause the vaginal wall tissue to become loose and brittle, making it susceptible to edema, tearing and bleeding, and suturing should be given promptly to avoid hemorrhage.