Management of Retained Lap Pad in the Vagina After Vaginal Delivery
Immediate removal of the retained lap pad from the vagina is essential, followed by a thorough examination to assess for potential complications and ensure no additional foreign bodies remain. 1
Initial Assessment and Management
- Perform a thorough vaginal examination to confirm the presence and location of the retained lap pad 1
- Ensure adequate lighting, visualization, and exposure for proper assessment and removal 1
- Consider regional or general anesthesia if removal is expected to be difficult or painful; otherwise, local anesthesia may be sufficient 1
- Place a Foley catheter before the procedure to prevent urinary retention 1
Removal Procedure
- Perform surgical site preparation with povidone-iodine or chlorhexidine gluconate (if allergic to iodine) 1
- Count all surgical instruments, sponges, and sutures pre- and post-procedure to ensure no additional foreign bodies remain 1
- Remove the lap pad carefully to minimize trauma to surrounding tissues 1
- After removal, perform a systematic evaluation of the vagina and perineum to assess for any injury or infection 1
Post-Removal Assessment
- Conduct a digital rectal examination to ensure no damage to the rectum and to confirm the integrity of the repaired first-degree laceration 1
- Assess for signs of infection such as purulent discharge, erythema, and edema 2
- Evaluate the first-degree laceration repair to ensure it remains intact 1
- If the laceration repair is compromised, consider repairing using continuous non-locking suturing techniques, which distribute tension more evenly and result in less pain 2, 3
Antibiotic Prophylaxis
- Administer broad-spectrum antibiotics such as a second or third-generation cephalosporin (e.g., cefoxitin 2g IV) 2
- For penicillin allergy, use gentamicin 5 mg/kg plus clindamycin 900 mg or metronidazole 500 mg 2
- Antibiotic administration is associated with lower rates of postpartum wound complications, including purulent discharge and overall wound complications 1
Post-Procedure Care
- Administer pain control with acetaminophen, ibuprofen, and ice packs 1
- Recommend sitz baths twice daily until the first wound check 1
- Prescribe stool softeners to achieve soft stools and prevent strain on the repair 1
- Arrange early follow-up within two weeks to assess healing 2
- Provide patient education on wound care and signs of complications 2
Documentation and Communication
- Clearly document the incident, including the time of discovery, removal procedure, and post-removal assessment 1
- Inform the patient about the retained foreign body, the removal procedure, and potential complications 1
- Document a comprehensive assessment of the perineum following removal 1
Potential Complications to Monitor
- Infection (rates of 0.1% to 23.6% reported with perineal trauma) 1
- Wound dehiscence (rates of 0.21% to 24.6% reported with perineal trauma) 1
- Pain and discomfort 1
- Dyspareunia and delayed resumption of sexual intercourse 1
Common Pitfalls to Avoid
- Failure to perform an adequate examination may lead to underestimation of potential damage 1
- Inadequate lighting during examination can cause misclassification of any injury 1
- Not recognizing the full extent of any trauma can lead to improper treatment decisions 1
- Failure to count all surgical materials before and after the procedure 1