Old chronic cervical laceration

　　Old chronic cervical laceration is mainly caused by childbirth injury. When the cervix is not fully dilated, cervical laceration may occur due to abrupt labor or instrumental delivery, as the presenting part is forced through. Cervical laceration can also be caused by excessive dilation of the cervix during artificial abortion. Specific reasons are as follows: 　　

1. Rapid delivery: excessive force during delivery, especially when the cervix is not fully dilated and the fetus is delivered rapidly, or improper use of oxytocin causing uterine forced contraction. 　　

2. Surgical procedures: such as improper placement of forceps, midwives trying to push the cervix upwards with their fingers inside the vagina, and artificial dilation of the cervix with instruments such as balloons and water bags. These can also cause cervical lacerations. 　　

3. Cervical lesions themselves: cervical edema, chronic cervicitis, malformation, and old scars. 　　

4. Abnormal fetal position: such as posterior position, transverse position, and facial position.

　　Old chronic cervical lacerations can also cause other diseases in addition to their clinical manifestations. After self-healing, fibrous tissue scars form, leading to relaxation of the cervical external os. It can also cause cervical prolapse. A few patients may have menstrual irregularities.

　　Main clinical manifestations:

　　1. Increased leukorrhea or sexual bleeding: Due to the inversion of the cervical canal mucosa, it is prone to infection, causing cervical congestion and edema, and an increase in secretions, with leukorrhea being purulent or mucoid. Excessive leukorrhea can lead to secondary vulvovaginitis and vulvar itching. Examination shows inversion of the cervical canal mucosa, tissue congestion, and fragility, and bleeding during sexual intercourse.

　　2. Low back and sacral pain: When cervicitis is severe, inflammation spreads along the sacral ligament and cardinal ligament, forming pelvic adnexal inflammatory disease, causing low back and sacral pain, and lower abdominal distension.

　　3. Habitual abortion: If the laceration occurs at the cervical internal os, it can cause separation of submucosal muscle fibers and connective tissue, leading to relaxation of the cervical internal os and cervical dysfunction, resulting in habitual abortion, which often occurs in the second trimester of pregnancy.

　　4. Intrauterine device: Due to the relaxation of the cervix orifice, intrauterine devices are prone to fall out.

　　5. Gynecological examination: The external os of the cervix appears like a fish mouth, the anterior and posterior lips of the cervix are inverted, and the cervical mucosa is prolapsed, which is prone to bleeding during examination. Palpation shows a hard cervix quality and a relaxed cervix orifice.

　　To prevent old chronic cervical lacerations, attention should be paid to the following aspects:

　　1. After natural delivery and instrumental assisted delivery, routine examination of the cervix for lacerations should be performed. If severe lacerations are found, they should be repaired promptly.

　　2. Take contraceptive measures to reduce intrauterine manipulation. During induced abortion, the dilatation of the cervix should be increased sequentially according to the serial number of the dilator, without skipping numbers and not using excessive force. When the gestational age is larger, cervical dilatation drugs should be used before surgery, and the operation should be performed after the cervix is dilated.

　　In the diagnosis of old chronic cervical lacerations, in addition to relying on clinical manifestations, auxiliary examinations are also needed. This disease can be diagnosed by abdominal ultrasound examination, where a明显 scar at the cervix can be seen, appearing pale white.

　　Patients with old chronic cervical lacerations can be treated with cervical laceration repair surgery. Both before and after surgery, attention should be paid to diet and health care, with light and tasty food, more vegetables and fruits, and less sweet, spicy, and stimulating foods.

　　1. Diet should be light, avoiding foods such as lamb, shrimp, crab, eel, salted fish, black fish, and other irritants.

　　33. 2. Eat more lean meat, chicken, eggs, quail eggs, crucian carp, turtle, white fish, cabbage, asparagus, celery, spinach, cucumber, winter melon, mushrooms, tofu, kelp, nori, and fruits, etc.

　　32. 3. It is appropriate to eat some nourishing yin foods and take drugs that tonify qi and blood.

　　31. 4. Protein is an important component of antibodies. If intake is insufficient, the body's resistance will decrease. For the first half month after the operation, 1.5 to 2 grams of protein per kilogram of body weight should be provided, with an approximate daily intake of 100 to 150 grams. Therefore, it is advisable to eat more chicken, lean pork, eggs, dairy products, and soy products, etc.

　　30. 5. On the basis of normal diet, appropriate fat intake should be restricted. The fat intake should be controlled at about 80 grams per day for one week after the operation. For those with menstrual disorders, spicy foods such as chili, alcohol, vinegar, pepper, ginger, etc., should be avoided, as these foods can cause congestion of the reproductive organs, increase menstrual flow, and also avoid cold foods such as crabs, snails, and clams.

　　29. After cervical repair surgery, due to the body's weakness, sweating is often frequent. Therefore, water intake should be small and frequent to reduce the amount of water evaporation; sweat contains a large amount of water-soluble vitamins, especially vitamin C, vitamin B1, and vitamin B2, so it is advisable to eat more fresh vegetables and fruits. In this way, it is also beneficial to prevent constipation.

　　28. Do not eat spicy or刺激性 food, as it may exacerbate pelvic congestion and inflammation, or cause excessive contraction of the uterine muscle, thereby aggravating symptoms, such as chili, pepper, garlic, scallion, ginger, leek, chicken soup, durian, longan, jujube, ejiao, royal jelly, and other hot, coagulant, and hormone-containing foods should also be eaten in small amounts.

　　Methods for surgical treatment of old cervical lacerations:

　　24. 1. Minor lacerations generally heal naturally without affecting the body. For patients with cervical mucosal eversion, repair surgery or cervical conization can be performed, but improper suturing can cause infertility, so it is less commonly used for those who wish to have children.

　　23. For habitual abortion caused by cervical insufficiency, cervical cerclage is performed at 14-16 weeks of gestation.

　　22. If the age is already quite large and there is no intention to become pregnant in the future, the erosion of the cervix has been treated, then there is no need to repair the old cervical laceration.