From the Research
For a suspected cervical laceration with hemorrhage during vaginal delivery, sterile vaginal packing should be used to control bleeding while preparing for definitive treatment. The recommended approach is to use sterile gauze rolls or commercial vaginal packing soaked in sterile saline or an antiseptic solution such as povidone-iodine (avoiding strong concentrations that could cause tissue damage) 1. The packing should be placed firmly against the bleeding site using ring forceps or sponge holders, working from the apex of the vagina downward in a systematic, layered fashion until the entire vaginal canal is filled. This packing provides direct pressure to the bleeding vessels and promotes clotting. However, vaginal packing is only a temporary measure to stabilize the patient while arranging for definitive treatment, which typically involves surgical repair of the laceration under adequate anesthesia and exposure. The packing should not remain in place for more than 24 hours due to infection risk, and prophylactic antibiotics (such as a broad-spectrum cephalosporin) should be administered 2. Throughout this process, the patient requires close monitoring of vital signs, bleeding, and urine output, as cervical lacerations can cause significant hemorrhage and hemodynamic instability. Some studies have investigated the risk factors for cervical lacerations, including operative vaginal delivery, nulliparity, and episiotomy 3, 4, but the immediate concern in the case of suspected cervical laceration with hemorrhage is to control the bleeding and stabilize the patient. Given the potential for significant blood loss and hemodynamic instability, prompt and effective management of the bleeding is crucial, and sterile vaginal packing is a recommended initial step in this process 5.
Key Considerations
- Sterile vaginal packing is used to control bleeding temporarily.
- The packing should be soaked in sterile saline or an antiseptic solution.
- Prophylactic antibiotics should be administered to prevent infection.
- Close monitoring of the patient's vital signs, bleeding, and urine output is necessary.
- Definitive treatment typically involves surgical repair of the laceration under adequate anesthesia and exposure.
Management Approach
- Place the packing firmly against the bleeding site.
- Work from the apex of the vagina downward in a systematic, layered fashion.
- Fill the entire vaginal canal with the packing material.
- Limit the duration of packing to 24 hours or less to minimize infection risk.
Given the most recent and highest quality evidence, the approach to managing a suspected cervical laceration with hemorrhage during vaginal delivery prioritizes immediate control of bleeding and stabilization of the patient, with sterile vaginal packing being a critical initial step 1.