VISCERAL INJURIES TO THE BIRTH CANAL

BLADDER: Causes- Obstetrical injury to the bladder may be due to:

1. A) TRAUMATIC—
2. Instrumental vaginal delivery such as destructive operations or forceps delivery especially with Kielland
3. Abdominal operation such as hysterectomy for rupture uterus or cesarean section.
4. B) SLOUGHING FISTULA - It results from prolonged compression effect on the bladder between the head and symphysis pubis in obstructed labor.

DIAGNOSIS:

1. A) TRAUMATIC -

• Urine dribbles out soon following the operative delivery. Blood stained urine following cesarean section or hysterectomy is suggestive of bladder injury.
• Margins are clean cut with oozing surfaces.

1. B) SLOUGHING FISTULA

• 1)History of prolonged labor.
• 2)Dribbling of urine occurs after varying interval following delivery (5–7 days).
• 3)Margins devitalized and necrosed.
• 4)Missing of a chunk of tissue.

MANAGEMENT: Traumatic fistula: Immediate local repair is preferable, if the local tissues are healthy. In unfavorable condition, a self-retaining catheter is introduced and to be kept for 10–14 days or even longer. Urinary antiseptics are prescribed. In favorable condition, there may be spontaneous closure of the fistula. If it fails, repair is to be done after 3 months.

SLOUGHING FISTULA: Repair should not be attempted as the conditions are not ideal (vide supra), instead, a self-retaining catheter is placed as outlined above. Repair is to be done after 3 months.

RECTUM: Rectal injury, other than that involved along with complete perineal tear is rare in obstetrics.

This is because, the middle-third of the rectum is protected by the curved sacral hollow and the upperthird is protected by the peritoneal lining. Prolonged compression of the rectum by the head in midpelvic contraction with a flat sacrum predisposes to ischemic necrosis of the anterior rectal wall and results in rectovaginal fistula. The repair in such cases should be postponed for at least 3 months.

URETHRA: Urethral injury may be traumatic resulting from instrumental delivery or during pubiotomy; may be ischemic sloughing, the mechanism of which is similar to that of bladder necrosis. The principles in management are similar to those of bladder injury.

HOMOEOPATHIC MEDICINE FOR MANAGING VISCERAL INJURIES: -

There are many Homoeopathic remedies which can manage Visceral Injuries very effectively.

The medicines are:-Bellis perennis, Hypericum perfoliatum, Aconitum napellus, Arnica Montana, Calcarea phosphorica, Calendula, Ipecacuanha, Ledum palustre