Female reproductive organ trauma

　　The causes of female reproductive organ trauma often include dystocia, prolonged second stage of labor, difficult labor, history of midwifery, long-term increase in abdominal pressure, weakness, malnutrition, and early postpartum physical labor. In the observation of labor, it is very important to correctly estimate the size of the fetus, understand the position and position of the fetus, and prevent premature labor. For women with posterior fetal position and narrow outlet, it is necessary to perform a median episiotomy during the forceps delivery, and bilateral incisions can be made if necessary, with attention to protect the perineum. The median episiotomy has its advantages when performed by a skilled person; however, if the operation technique is not skilled and the perineum is not well protected, the wound at the median episiotomy may continue to tear backward, leading to third-degree laceration, which is something worth paying attention to.

　　The most common complications of female reproductive organ trauma are perineal and sacral tail skin inflammation and pressure ulcers (bedsores, decubitus ulcers). Due to the stimulation of feces, the perineal skin is often in a moist and eroded state of metabolic products, prone to skin redness, swelling, and ulceration. The skin破溃infection can extend deep into the muscle layer or extend to the labia minora, inguinal groove, etc.; polluting the urethral orifice and vaginal orifice can cause retrograde infection, which not only increases the patient's pain but also brings difficulties to clinical nursing work.

　　Female reproductive organ trauma includes diseases such as anterior vaginal wall prolapse, posterior vaginal wall prolapse, uterine prolapse, and fecal fistula, and its symptoms are manifested as:

　　1. Anterior vaginal wall prolapse

　　1. Symptoms

　　Mild cases have no symptoms. Severe cases report a mass protruding from the vagina, accompanied by a sinking sensation and lower back pain.

　　2. Signs

　　According to the degree of prolapse or bulging of the anterior vaginal wall during examination, it is clinically divided into three degrees. Mild I degree: the bulging bladder is protruding downward along with the anterior vaginal wall and is still inside the vagina. Mild II degree: part of the anterior vaginal wall is exposed outside the vaginal orifice. Severe III degree: the entire anterior vaginal wall is prolapsed outside the vaginal orifice.

　　2. Posterior vaginal wall prolapse

　　1. Symptoms

　　Mild cases usually have no symptoms, while severe cases may have a sinking sensation, lower back pain, and difficulty defecating. Sometimes, one needs to push the prolapsed posterior vaginal wall with fingers to defecate.

　　2. Signs

　　Examination shows the posterior vaginal wall mucosa protrudes into a spherical mass, with relaxation of the vagina. The mass increases in size when holding one's breath. During rectal examination, the tip of the finger can enter the blind pouch convex towards the vagina. Patients often have old perineal laceration injuries. Clinical staging: similar to anterior vaginal wall prolapse.

　　3. Uterine prolapse

　　1. Symptoms

　　Mild patients generally have no discomfort, while moderate to severe patients often have varying degrees of lumbar sacral pain or a sinking sensation; symptoms are more pronounced when standing for a long time, after fatigue, or when abdominal pressure increases, and they improve after lying down and resting. Severe uterine prolapse is often accompanied by difficulties in urination and defecation, constipation, enuresis, or the presence of residual urine and stress urinary incontinence, and is prone to complications such as cystitis.

　　2. Signs

　　Intractable prolapse of the uterus is often accompanied by rectal and bladder prolapse, with thickened vaginal mucosa and hypertrophy and elongation of the cervix. According to the degree of descent of the uterus when the patient lies flat and exerts force while holding their breath during examination, China classifies uterine prolapse into three degrees. Mild I degree: the external os of the cervix is less than 4 cm from the hymen edge but has not reached it; Severe I degree: the external os of the cervix has reached the hymen edge but has not exceeded it, and the cervix is visible at the vaginal orifice. Mild II degree: the cervix has prolapsed out of the vaginal orifice, but the body is still inside the vagina; Severe II degree: the cervix and part of the body have prolapsed out of the vaginal orifice. III degree: the cervix and body are completely prolapsed outside the vaginal orifice.

　　4. Fecal fistula

　　Fecal fistula is mainly manifested as vaginal leakage of feces and flatus. In larger fistulas, formed feces can be excreted through the vagina, while thin stools continuously leak outwards and cannot be controlled.

　　To prevent female reproductive organ trauma, it is necessary to avoid intense exercise, reduce the pathogenic factors of trauma, strengthen prenatal care, adopt new methods of delivery, and properly handle labor. Reproductive organ injuries can be prevented, and the occurrence of fistulas will inevitably be greatly reduced. Preventing dystocia is one of the most important measures, so it is necessary to conduct prenatal examinations, such as abdominal ultrasound monitoring, blood HCG, etc., and consider cesarean section when necessary.

　　The routine gynecological examination for female reproductive organ trauma mainly includes two aspects:

　　1. Laceration during delivery

　　Perineal third-degree laceration occurs during the second stage of labor, when the fetal head is crowning, the midwife may feel a sense of tearing in the perineal area. Immediate discovery and suture of the third-degree laceration after delivery generally leads to good wound healing.

　　2. Chronic laceration

　　During the examination, one finger is inserted into the anal canal, and the patient is asked to exert force by holding back stool. At this time, the anal finger does not feel the contraction of the sphincter muscle, and due to the retraction of the torn muscle ends, small indentations can be seen on the side of the anus, and circular muscle ends can be found at the site of the tear.

　　Female reproductive organ trauma patients should eat more foods that promote wound healing, such as pigeon soup and mackerel soup.

　　1. Zinc:Deficiency of zinc can lead to a decrease in the function of fibroblasts. Zinc mainly exists in foods such as wood ear, kelp, pork skin, and pork feet.

　　2. Fats:Lack of fats can lead to defects in wound healing. Fish oil contains a rich amount of fatty acids with anti-inflammatory effects, which is beneficial for wound healing.

　　3. Glucose:Sugar is the main energy supplier for the human body, and providing sufficient energy is indispensable for wound healing. During the wound healing period, it is advisable to eat fruits rich in sugar, which can increase sugar intake and also consume a sufficient amount of vitamins.

　　4. Protein:Increasing protein in the diet can promote wound healing and reduce the chance of infection. Foods rich in protein include various lean meats, milk, eggs, etc.

　　5. Vitamin A:Can promote wound healing. It mainly exists in fish oil, carrots, tomatoes, and other foods.

　　6. Vitamin C:Can promote wound healing. It exists in various vegetables and fruits, and dates and chili peppers are treasure houses of vitamin C.

　　Foods that are不利于 wound healing, such as fermented bean curd, scallions, chili peppers, chives, etc., because they are prone to cause infection. In addition, smoking, bad mood, and lack of confidence will affect wound healing.

　　Symptomatic treatment and etiological treatment should be the most critical in the treatment of female reproductive organ trauma patients.

　　1. In cases with a small range of lesions and mild illness, conservative treatment such as local compression, hemostasis, anti-inflammatory, and rest can be adopted, waiting for natural recovery.

　　2. In cases with a large range of lesions, severe trauma, or suspected injury to other organs, immediate surgery should be performed for exploration, hemostasis, and repair, etc.

　　3. Pay attention to rest, increase nutrition, strengthen exercise, and apply antibiotics to prevent secondary infection.