Abnormal soft birth canal dystocia

Brief introduction of soft birth canal abnormal dystocia Dystocia caused by abnormal soft birth canal is far less common than dystocia caused by abnormal bone birth canal, so it is easy to be ignored and cause missed diagnosis. The soft birth canal includes the lower uterus, the cervix, the vagina, and the vulva. The lesions of the soft birth canal can cause dystocia, and other parts of the genital tract and surrounding lesions may also affect the soft birth canal, making it difficult to deliver, but the former is more common. Therefore, routine vaginal examination should be performed in the early pregnancy to understand whether the genital tract and pelvic cavity are abnormal. basic knowledge The proportion of illness: 0.12% Susceptible population: pregnant women Mode of infection: non-infectious Complications: dystocia, neonatal asphyxia

Soft birth canal abnormal dystocia

(1) Causes of the disease

1. Physical dysplasia

Uterine dysplasia, short perineum, small, long, vaginal stenosis, long cervical tube, small, hard, lack of stretch and elasticity, extended difficulty in childbirth.

2. Senior primipara

Maternal women over the age of 35 are older primiparas. If the marriage is 35 years old, the pregnancy is different from the 35-year-old primipara after 10 years of marriage. The former does not necessarily have dystocia, the latter may be due to genital dysplasia. Difficulty in childbirth, general soft birth canal laceration increases the chance of uterine prolapse. Because of high pelvic floor muscle group and dysplasia, the pelvic floor muscles and sarcolemma are easily damaged when the fetus passes, which is easy to form uterine prolapse.

(two) pathogenesis

There is currently no relevant information.

Soft birth canal abnormal dystocia prevention

There is no special prevention method for this disease and it is actively treated.

Soft birth canal abnormal dystocia complications Complications, dystocia, neonatal asphyxia

Prone to prolonged labor, maternal pain, and finally into dystocia, neonatal asphyxia. Neonatal asphyxia, one minute after the delivery of the fetus, only the heartbeat without breathing or the establishment of a hypoxic state of regular breathing. One of the main causes of death for newborns is the most common emergency after birth, which must be actively rescued and properly treated to reduce neonatal mortality and prevent long-term sequelae.

Soft birth canal abnormal dystocia symptoms Common symptoms Postpartum hemorrhage canal flat stenosis postpartum flexion bad premature rupture of membranes Cervical edema soft canal abnormal fatigue dehydration varicose pelvic mass

The type of abnormal soft birth canal.

Vulvar abnormality

(1) vulvar edema: venous tumor, varicose veins, genital stenosis is the cause of dystocia.

(2) vulvar tumor: can cause dystocia, vulvar abscess in the vaginal delivery when cutting and drainage.

(3) vulvar scars: general vulva after surgery and scars after perineal laceration, easy to tear during childbirth, vaginal delivery is difficult.

2. Vaginal abnormalities

(1) Congenital vaginal stenosis: Although it can soften after pregnancy, it causes laceration due to poor stretch during childbirth.

(2) vaginal surgery scars: such as uterine prolapse repair, high-inflammation scar formation, cervical laceration, softening during pregnancy, can be stretched open during childbirth, but can cause deep scar laceration, should be early Diagnosis, cesarean section is better.

(3) vaginal tumors: general vaginal cysts are only discovered during childbirth, can be puncture, other such as cancer, sarcoma, fibroids and other extensions are limited, brittleness is easy to hemorrhagic infection, to achieve adequate cesarean section.

(4) vaginal mediastinum: the complete mediastinum extends from the uterus to the cervix to the vagina. The vagina often has a double uterus and a double cervix deformity. It is completely mediastinal. Generally, half of the vagina can be fully expanded after the fall of the fetal head, and the mediastinum is not The upper and lower parts may not interfere with the lowering of the fetal head, and sometimes it will naturally rupture. However, if it is thick, it must be cut off. After the baby is delivered, the remaining septum is removed and the stump is locked with the gut.

(5) vaginal septum: the vaginal diaphragm is located in the vagina, the middle section, after the postpartum anal examination can be misdiagnosed as the cervix, but can feel the cervix is above the level of the diaphragm, through the vaginal examination in the upper side of the diaphragm To the outside of the cervix, such as the cervix has been opened, the fetal head is lowered to the bottom of the pelvis with a finger to expand the diaphragm or X-shaped incision, and then the baby is delivered after the lock seam is cut. If it is difficult, the cesarean section should be used.

3. Cervical lesions

(1) Cervical lesions: infection after cervical laceration causes left and right cervix rupture, irregular laceration scar, hard knot, uterine stenosis, prolonged labor after labor, forced clamp production can cause deep laceration, bleeding, It is still better to choose cesarean section.

(2) cervical stenosis: due to the previous difficult birth caused by severe destruction of the cervical tissue or infection caused by stenosis, general softening of the cervix after pregnancy, the cervix can not expand or slow expansion after delivery should be cesarean section.

(3) cervix adhesion: during the delivery process, the cervical canal has disappeared but the cervix does not open, the cervix is covered with a small head, and there is a thin layer of cervical tissue between the exposed part and the vagina. Under 2cm, it can be broken by hand, the cervix mouth will expand quickly, or it can be 10 points at the edge of the uterus, the cervix can be cut 1~2cm at 2 and 6 o'clock, and then the forceps can be used to assist the labor, but the cervix has tears. The danger of cracking.

(4) large opening of the cervix: the contraction is normal, the labor process is progressing smoothly, the fetal head has been connected, the uterus is open, the cervix disappears, only the external uterus opens the fingertips, and the outer mouth is as thin as a paper bag. Open, the primipara occurs in the process of childbirth, the uterus mouth is incomplete, the uterus can cause uterine rupture, divided into two types of primary and secondary.

1 primary cervix abnormalities: congenital defects, non-pregnancy, small cervix and cervix, no abnormalities in the histology of childbirth during childbirth.

2 secondary uterine anomalies: abnormalities of extrauterine mouth histology, such as multiple births, multiple abortion history, scars on the edge of the cervix, uterine vaginal stiffness, past cervix incision, or cervix, After vaginal laser treatment, as well as cervical cancer, etc., most of the mothers, if not treated, uterine rupture, occasional partial necrosis of the cervix, a round-shaped shedding and bleeding.

The above cervical tube abnormalities, suspicious in the history of labor, can be vaginal examination, early detection, early treatment.

(5) Cervical edema: common in the flat pelvis, pelvic stenosis, pelvic wall and head between the head of the cervix edema, which is the pressure of the fetal head, blood flow disorder caused by the opening of the cervix, long time The pressure forced the delivery to stagnate, such as mild edema, puncture and removal of tension can make the cervix open and yield, and the severe cesarean section.

(6) Dislocation of the extrauterine mouth: At the beginning of childbirth, the first part of the uterus enters the anterior wall of the cervix, and the posterior wall of the cervix is poorly dilated. The cervix is pushed to the direction of the tibia and is displaced backwards and upwards, called OS.Sacralis. At the humeral condyle, the anus can not be touched by the fingers, causing dystocia expansion and dystocia, but during the delivery process, the posterior superior cervix is moved to the center and the pelvic axis is the same, which can be opened and the child is born. For example, Gongkou can not turn to the center, the mouth of the palace is blocked, the labor process is prolonged, resulting in dystocia, affecting maternal and child health.

(7) Adhesion between the cervix and the membrane: due to inflammation, the lower part of the cervix adheres to the membrane of the cervix, making the labor progress slow. For example, the vaginal examination can reach into the deep part of the cervix and peel off, so that it can be separated from the lower part of the uterus, the cervical wall, and the amniotic sac. Formation, the labor process is progressing very quickly.

(8) Cervical fibroids: pregnancy with cervical fibroids is relatively rare, accounting for about 0.5%, most of the uterine fibroids with pregnancy, cervical fibroids, when the delivery of the palace contraction and the cervical traction is blocked, causing dystocia.

When the subserosal fibroids are invaded in the Douglas nest, the childbirth disorder is obvious, and the vaginal examination is confirmed. The cesarean section is appropriate.

(9) Cervical cancer: generally 20 to 30 years old women with cervical cancer at the beginning of childbirth, lack of stretch and elasticity of the cervix, cervix opening obstacles, tissue fragility, causing laceration, bleeding, oppression and necrosis, infection and other risks According to the symptoms of maternal premature examination, timely diagnosis can be done selective cesarean section, cervical cancer patients during childbirth, first cesarean section, after taking out the fetus, if conditions permit, you can do extensive hysterectomy, otherwise postoperative Radiation laser treatment.

(10) Cervical stiffness:

1 Cervical hardening: divided into upper cervix hardening, refers to cervical abnormalities or cervical muscle insufficiency, hardening of the lower part of the cervix, refers to the hard tissue of the cervical connective tissue is the immature cervical, which affects the softening, disappearance, and exhibition of the cervix The Pinghe cervix opens and the fetal head enters the basin, causing dystocia.

2 The connective tissue of the cervical canal is hard and abnormal, which makes the cervix immature. If it is in labor, the cervix is incomplete, the cervix is open to the fingertips, the labor process is prolonged, the fetus is suffocated, the labor process is stagnant, and cesarean section is required.

4. Uterine abnormalities

(1) uterine prolapse: the uterus is completely prolapsed, gradually rises to the abdominal cavity after 4 months of pregnancy, no longer escape, no pelvic floor resistance during childbirth, delivery is faster, but the palace is in the abdominal cavity, the cervical canal is long and prolapsed Outside the vagina, due to connective tissue hyperplasia, hypertrophy, affecting the opening of the cervix, during the delivery process, premature rupture of membranes, prolonged labor, intrauterine infection, cervical laceration, sudden rupture of the membrane, downward force, cervical edema It affects the opening of the palace and causes dystocia.

(2) uterine torsion: the cervical part of the uterus of pregnancy, divided into the upper part and the lower part, the upper part is reversed, which can cause fetal death in severe cases. When the vaginal examination is performed, the fingers are not easy to enter the internal cervix to confirm the diagnosis, and the delivery is terminated early. Diagnosis or triad diagnosis is a good diagnosis.

(3) uterine height flexion and anterior abdominal wall fixation: the uterus of the pregnancy is anterior flexion, the height of the uterus is drooping, the drooping abdomen, the cervix is pulled upwards, the birth of the fetal head is difficult, and the premature rupture of membranes is easy. Strong uterine contraction causes the cervix to be thinned upwards, the cervix is open slowly, and the head of the cervix is pressed against the posterior wall of the cervix, which can cause the posterior wall to rupture. The uterus is fixed after the abdominal wall is fixed, and the uterus is also abdomen. The head of the child oppresses the posterior wall of the cervix, and is overstretched. Similarly, there is a risk of rupture in the posterior wall. If there is such a history or a drooping abdomen, it is vigilant and early estimation can be used for selective cesarean section.

(4) Uterine malformation:

1 Separate double uterus, double cervix and double horn uterus: isolated double uterus or double cervix, double horn uterus similar to single uterus, poor development, few full-term production, general cervix opening obstacles, basin The head is not called, the prolonged labor is prolonged, and once the selective cesarean section should be detected, the uterine malformation is divided into 19 types (Fig. 1), and the abnormal fetal position of the abnormal intrauterine pregnancy is divided into 8 types.

2 single cervical double-horned uterus: the uterus two short angles, similar to the septum uterus, combined with more breech, more comorbidities, cesarean section is appropriate.

3 septal uterus or incomplete septum uterus: mostly infertility, miscarriage after pregnancy, premature birth, factor palace has lieutenant, egg membrane enlargement, obstacles occur, lateral or breech occurs, postpartum placental dissection occurs, postpartum More bleeding, easy to miss diagnosis, mostly X-ray examination was discovered.

4 double-horned uterus: the end of the uterus bulges into the uterus, mostly in the transverse position after pregnancy.

5 single-horned uterus: This is a side of Muller tube development, one side of dysplasia, more breech after pregnancy, generally can not reach full-term, miscarriage, premature birth, uterine muscle dysplasia, once the labor is weak, the labor process is prolonged There are many maternal and child comorbidities. Uterine rupture is easy to occur during childbirth. Unicorn uterus pregnancy is slightly better than uterine uterus pregnancy. 50% of uterine uterus pregnancy has uterine rupture. It should be examined during pregnancy and diagnosed early.

(5) uterine hypoplasia: uterine hypoplasia combined with ovarian dysfunction, so most infertility, that is, abortion occurs in pregnancy, premature birth, when the full-term, the cervix is open, the pain is weak, the labor process is prolonged, to save The fetus does more cesarean section.

(6) uterine constriction ring: during the process of delivery, the local muscles in the lower uterus or intrauterine mouth occur sputum, that is, long labor, maternal fatigue dehydration, uterine muscle function uncoordinated contraction, with the uterus mouth as a good hair In part, part of the stenosis is narrowed, and the neck and waist of the fetus are tightly entangled, and the abdomen can be touched with a part of the sag, and the narrowed ring of the bulge can be touched in the uterine cavity. The opening period can be narrowed near the uterus. Because of compression, the cervix is loose, edema, cervical tightening, difficulty in lowering the head, prolonged labor, bladder, rectum compression, such as a narrowing ring after delivery, can cause the incarceration of the placenta, the uterus constriction after relaxation In order to deliver the fetus or placenta, if necessary, cesarean section should be used to save the fetus.

5. Uterine fibroids with pregnancy

Uterine fibroids increase with the gestational age of pregnancy. The uterine fibroids undergo red degeneration during pregnancy and puerperium. Local pain and tenderness are accompanied by hypothermia and white blood cell growth. Antibiotic treatment is required for combined infection.

Submucosal fibroids with pregnancy, prone to miscarriage, premature delivery, affecting placental function, pregnancy to full term, due to submucosal fibroid prolapse to the vaginal infection, once diagnosed, fetal maturity can do selective cesarean section surgery.

After the intramuscular fibroids are in labor, the uterine contraction is weak, the labor process is prolonged, and the growth of the cervical fibroids or the lower uterine fibroids or the subserosal fibroids embedded in the pelvic cavity all cause obstacles in childbirth. The tumor has a greater impact. After the diagnosis, the selective cesarean section is performed early. The uterus that has undergone myomectomy has the possibility of scar rupture during childbirth and cannot be ignored.

General uterine fibroids with pregnancy, the mode of delivery should be based on the position of the fetal head and fibroids, such as fibroids above the pelvic cavity, the fetal head has been into the basin, such as uterine contractions, normal progression of labor, natural delivery, such as fibroids Located below the first exposed part, the fetal head is floating, there is a certain difficulty in vaginal delivery, cesarean section should be performed, and no sarcoma removal is usually performed during cesarean section.

6. Pelvic tumor

(1) ovarian cysts: pregnancy with ovarian cysts, occurs in the third trimester of pregnancy and puerperal pedicle torsion, if the ovarian cyst obstructs the birth canal, can lead to rupture of the ovarian cyst, or obstruction of childbirth, occasionally can cause uterine rupture, so diagnosed After the operation, the ovarian cyst should be removed during the 4th month of pregnancy or the postpartum period. If the ovarian cyst is incarcerated in the pelvic cavity after cesarean delivery, cesarean section should be performed.

(2) pelvic mass: clinically rare, occasionally there may be severe bladder fullness, or vaginal bladder bulging, vaginal rectum bulging, sagging kidneys and other obstructing pelvic cavity, obstructing childbirth, feasible cesarean section.

Soft birth canal abnormal dystocia check

According to the condition, clinical manifestations, symptoms, signs, X-ray, B-ultrasound, etc. are selected.

Diagnosis of abnormal dystocia in soft birth canal

Diagnostic criteria

1. The degree of cervical cervix dilatation, thickness, softness (based on the peak of uterine contractions), cervix with edema and edema, degree, whether there is a gap between the cervix and the fetal head at the peak of uterine contractions, these are difficult to produce Judging the type, nature and extent is very helpful.

2. Check the position of the fetus: the direction of the sagittal suture and the position of the anterior and posterior sacral cerebral palsy are the most important. Special attention should be paid to the edema of the fetal head and the anterior sac of the skull. The squat is misunderstood and the sagittal suture is not touched. It is clear that in the second stage of labor, the vaginal examination before the surgical midwifery often uses the direction of the auricle to help determine whether the fetal position is accurate.

3. Clearly reveal the level: This is extremely important for the diagnosis of dystocia (including whether the first exposure of the fetus can pass through the bone birth canal) and the decision-making method (vaginal midwifery or cesarean section), which does not allow obvious errors, so it should deal with those serious fetal heads. The edema person pays special attention to the minimum point of the skull as the first exposure level of the skull. Sometimes it is necessary to check with the other hand on the maternal abdomen (pubic symphysis) whether the double top diameter of the fetal head has passed the pelvic entrance plane. For those with severe fetal head deformation, sometimes the lowest point of the fetal head has even been exposed, but the double top diameter is also stuck above the pelvic entrance.

Differential diagnosis

Vestibular gland abscess

The disease mostly occurs in the reproductive age, the infection is mostly unilateral, local severe pain, check see the side of the labia majora or the perineum is red and swollen, hard, tender, obvious, large eggs, touch the lumpy lumps, if the surrounding tissue Infected, often accompanied by inguinal lymphadenopathy, peripheral blood leukocyte count increased, neutrophils increased significantly, the two are easy to identify.

2. Vestibular gland cyst

After the acute phase of vestibular gland inflammation, the glandular orifice is blocked, the secretions in the gland can not be discharged, and the vestibular gland cyst is formed. The patient has a feeling of bulging. The local skin color is normal, the mass is cystic, and the labia is confined to one side. The posterior 1/3 of the deep part is not connected with the skin, and the activity is good. The cyst is too large to affect the first exposed part of the fetus. Because it is mostly swollen on one side of the genital area, it is easy to identify.

3. Vulvar hemangioma

It is a congenital vascular structural abnormality, not a true tumor. It has various forms. It can become small or even disappear when acupressure, and it can be restored to its original state after relaxation. On the surface of some hemangiomas, varicose veins or local skin color are seen to be purple, and spongy vessels The shape of the tumor is irregular, and it can be lobulated, with a wide range of lesions, which can affect the perineum, vagina and anus. The position of the tumor is generally deep, the appearance is dark purple, and the color is faded when pressed, and sometimes it can affect the first exposed part of the fetus.

4. Obesity

Obese maternal, fat accumulation makes the vulva hypertrophy, sometimes must be differentiated from vulvar edema, obese maternal, vulvar skin tissue is soft, opaque and tension-free, does not affect the delivery of the first exposed part of the fetus, no laboratory abnormalities such as hypoproteinemia.

5. Vulvar varicose veins

Usually only see the subcutaneous vein, but due to long standing or in the third trimester of pregnancy, the venous bulge such as scorpion-like curvature, due to circulatory disorders, long-term expansion of blood vessels, can make one or both sides of the labia swelling, affecting the first exposed part of the fetus, childbirth If the varicose veins are severe, care should be taken to prevent rupture and infection.

6. Vulvar elephantiasis

Due to long-term chronic inflammation of the vulva, it affects the deep dermal connective tissue, causing it to fibrosis, lymphatic obstruction affecting lymphatic drainage, resulting in lymphatic accumulation in the lymphatic vessels, resulting in abnormal enlargement of the labia on one or both sides. The texture is tough and shaped like a skin. More common in the clitoris and the size of the labia, the skin surface is rough, pigmentation, thickening and hard, sometimes with non-neoplastic lesions in the vulvar epithelium, keratinization is obvious, there are many cleft palate, severe cases affect the first exposed part of the fetus.

7. Vulvar scars

The vulva skin tissue is hard, the elasticity is poor, there is skin scar in the vulva, the vulva can be caused by scar contracture, and the vaginal opening is narrow, which makes it difficult to deliver the first exposed part of the fetus.

8. Vulvar intraepithelial non-neoplastic lesions

It refers to skin diseases caused by various factors, such as vulvar skin and mucous membrane pigmentation, which may be related to chronic vulvar malnutrition. The range of lesions varies, mainly affecting the labia majora, the clitoris foreskin and the posterior labia, often symmetric. The patient has long-term genital itching, accompanied by pain after scratching. The skin in the ward is thickened like leather, the elasticity is poor, the ridge has wrinkles or scales, the eczema changes, the color of the vulva is dark red or pink, and the boundary is mixed. Clear white patches, thinning of the skin and mucous membranes, dry and chapped, loss of elasticity, blocked by the first exposed part of the tire, can cause abnormal labor.

9. Should be differentiated from vulvar papilloma

Clinically seen papilloma is only a papillary appearance, it is a tumor-like hyperplasia, often a single hair, can grow in any part of the vulva, but more common in the labia majora and clitoris, many tumors with pedicles, the shape is Grape-like or cauliflower-like, the tumor grows slowly, and there are no other symptoms except for the feeling of falling. Pathological examination: the surface of typical papilloma is stratified squamous epithelium, the epithelium is divided into finger-like protrusions, sacral papilloma, and the nipple is fine. Density, microscopic examination showed hyperplasia of the epithelial layer of the spine, but no thickening of the epithelial nail.

10. It should be differentiated from the external cervix that is no longer expanding.

During vaginal examination, the finger can enter the exposed part of the cervix after it is no longer dilated. If the vaginal is separated by a small hole, the finger can not touch the exposed part of the anterior part, and the external cervix can be felt at the transverse part. Above the level, extending into the curved probe can realize that there is a gap behind the small hole. If the hole is large, the finger can be inserted into the outer mouth of the cervix, which can confirm the diagnosis. If the tire touches the first exposed part and tightly The diaphragm and its slit above the exposed part of the baby are also misdiagnosed as an unexpanded cervix, especially when the cervix is fully dilated. If the cervix is not fully dilated, it can be touched by the fingers. The external cervix and the surrounding exposed part of the cervix, if the cervix has been opened, the first exposed part of the fetus descends to the bottom of the pelvis and expands with a finger or X-shaped incision. After the fetus is delivered, the suture is continuously sutured. Cutting edge, if the position of the transverse position is high and the toughness is thick, it hinders the lowering of the exposed part of the fetus, and it is better to end the delivery by cesarean section.

11. Vaginal septum

Vaginal stenosis should be identified with vaginal septum, vaginal stenosis occurs in the lower part of the vagina, affecting sexual life, thick tissue at the stenosis can affect the vaginal delivery of the fetus, vaginal transection occurs in the vagina, the middle junction, the impact on sexual life Not large, the majority of the vaginal septum is thin, after the delivery, the septum is thinned by the first exposed part of the fetus. After the cut, the vaginal delivery can be delivered, and the vaginal stenosis can not be delivered through the vagina.

12. Vaginal surgery scar

More common in uterine prolapse repair, severe vaginal inflammation, scar formation after cervical laceration, mild scars may soften after pregnancy, after the birth of the fetus first exposed, the scar continues to expand, often overcome the obstacles to complete the delivery, but It may cause scarring and severe bleeding and massive bleeding.

13. Vaginal oblique

Refers to the double uterus, double cervix, double vagina, congenital malformation of one side of the vaginal completely locked or incompletely occluded, one side of the vaginal complete abdomen is severely dysmenorrhea, the vaginal canal can reach the cystic mass with large tension, and the vaginal swelling to the unobstructed side Out, affecting the decline of the first exposed part of the fetus and delivery, one side of the vaginal incomplete closure often dysmenorrhea, check the vaginal swell of the cyst, sometimes visible small holes, compression cysts have old blood or purulent discharge from the small hole It also affects the drop and delivery of the first exposed part of the tire.

14. levator ani muscle

Rarely, the vaginal opening is a medium-thickness narrow ring, which seriously hinders the delivery of the baby's first exposed part. The vaginal examination reveals that the vaginal opening forms a narrowing ring, usually undergoing epidural anesthesia to relieve spasm.

15. Cervical scars

There are many cervical resections, deep cervical cervix or history of cervical laceration during childbirth. Due to the chronic inflammation of the cervix persists for a long time, the increase of connective tissue makes the cervical tissue hard and tough, or the cervical cervix is repaired due to infection after cervical laceration. Scars caused by irregular laceration, induration, narrowing of the cervical canal, although the cervix softens during pregnancy, can still lead to prolonged labor after labor, cervical examination has different degrees of scarring, if the uterus contraction is strong, and cervical dilation Unsatisfactory, forced forceps can help cause deep cervical laceration and massive bleeding, and should be delivered by cesarean section.

16. Cervical toughness

More common in advanced primipara or chronic cervicitis with cervical hypertrophy, cervical toughness and lack of elasticity; or maternal hyperactivity, cervical contracture, both of the cervical tract after labor is not easy to expand, intravenous injection of diazepam 10mg, or in the cervix Each side is injected with 0.5% lidocaine 5ml or atropine 0.5mg. If the cervical cervix is still not expanded, cesarean section should be performed.

17. Cervical external adhesion

The adhesion of the external cervix is often found when the progress of labor is blocked. The cervical canal has disappeared but the cervix does not expand. The outer cervix is still a small hole. It can not be expanded and opened. The edge is extremely thin. There is a thin layer of cervical tissue separated from each other, similar to the above-mentioned vaginal high-level diaphragm. At this time, the adhesive is used to separate the small pores, and the cervix can expand rapidly. In rare cases, radial incision is required. The reason may be Mild inflammation of the cervix during pregnancy causes adhesions, or there are tougher ring-shaped muscle fibers around the external cervix, so it is not easy to dilate.

18. The internal cervix and the membrane adhesion

As a result of inflammation, the internal cavity of the cervix and the membrane of the membrane cause the progress of the process to be slow. The vaginal examination reveals that a membrane adheres to the internal cervix. It can be extended into the cervix and peeled off to separate it from the lower uterine segment and the cervical wall. Progress in labor.

19. Should be differentiated from cervical valgus

Cervical eversion occurs after the cervix is damaged. Because of self-healing, it forms a firm fibrous scar, and the external cervix is loose. If the infection is combined, the cervical mucosa that causes edema and congestion is protruding beyond the cervical canal or fails to be operated in time. Repair, formation of scar contracture, cervical mucosa exposed to the outside, and the formation of cervical valgus, sometimes can cause prolonged labor or severe cervical laceration.

20. Cervical polyps

It must be differentiated from cervical submucous leiomyomas. Cervical polyps are formed by local hyperplasia of cervical mucosal inflammation. The tumors are prominent from the external cervix. They are mostly single or multiple, and the color is red and tongue-shaped. Crisp, pathological examination can confirm.

21. Cervical cancer

Cervical submucosal leiomyomas should be differentiated from cervical cancer in secondary infection. Cervical smear cytology can find cancer cells and help identify them.

22. Should be differentiated from cervical hemangioma

Cervical hemangioma is rare, mostly capillary or cavernous vascular type. It may cause hemorrhage due to cervical dilation during childbirth. In particular, cavernous hemangioma is composed of larger blood vessels, which may cause massive bleeding and even endanger maternal life. When the inspection is carried out, a dark red or purple boundary area is visible, and the pressure fades, and then relaxes and returns to the original state.

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