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How sutures dissolve. How to treat internal and external seams after childbirth

Childbirth does not always go flawlessly; if it is accompanied by ruptures, then stitches are required. This also applies to caesarean section, but you shouldn’t worry too much - although the presence of stitches has a certain impact on the quality of life, the body recovers over time. In this situation, how long it takes for the sutures to dissolve after childbirth is directly related to where they are located.

Location of seams

They can be placed either in the vagina, in the perineum or on the cervix.

Absorbable materials are used for this; the operation itself is performed either under intravenous anesthesia, or after treatment with Novocaine or Lidocaine. The choice of pain relief depends on the number of tears and their size. A certain amount of soreness in the suturing area is present, regardless of whether the perineum or vagina is sutured. In this regard, sutures on the cervix cause the least discomfort. Being inside, they are not as painful as external stitches, which are felt with every movement.

Sutures in the perineum can be the result of both ruptures and artificial dissection. The latter heal easier. They also differ in severity:

  • Skin tears at the posterior commissure are considered the mildest;
  • moderate severity of rupture of vaginal skin and muscles;
  • the most severe are ruptures accompanied by injury to the walls of the rectum. In this case, it is best to ask your doctor about how long it takes for sutures to heal after childbirth.

How are the stitches sutured?

First, the issue of anesthesia is decided, so you should not be afraid that this will be done “live.” Although often the release of adrenaline into the blood after childbirth is so great that even stitching without anesthesia does not feel as painful as childbirth itself. Sutures are applied to the perineum in layers, first the internal injuries are sutured, then the muscles and lastly the skin. Non-absorbable materials can be used for it. For greater safety, such threads are impregnated with antibiotics so as not to cause an inflammatory process. Removal of superficial sutures is usually carried out before discharge from the maternity ward. The internal sutures dissolve on their own.

Suture after caesarean section

It requires special mention. Depending on what kind of incision is made, longitudinal or transverse, the suture can be intradermal cosmetic or nodal. The latter is applied during transverse dissection, as it is more durable. IN in this case healing of sutures after childbirth takes longer. Both types of suture are quite painful, but the internal subcutaneous one is more aesthetically pleasing. appearance. Regardless of which suture is applied, antibiotic therapy is mandatory. The scar forms on the skin approximately 7 days after the operation, at the same time the silk external sutures are removed. The internal ones dissolve on their own, 2-3 months after birth, without causing discomfort to the mother in labor. Main problem sutures after cesarean section - this is the possibility of the formation of adhesions. It is impossible to prevent them with a guarantee, but it is believed that an active lifestyle, naturally within reasonable limits, helps normalize blood circulation and normal restoration of the body. Therefore, it is recommended to get out of bed as early as possible, as soon as the doctor allows it, regardless of pain in the suture area and fears associated with its strength.

Suture dissolution time

The main indicator of what determines how long it takes for sutures to heal after childbirth is the type of thread with which they were made. If the base material for them is catgut, then the duration of the resorption period can vary from a month to four. The location of application and the diameter of the thread also have a significant influence on this. Dacron threads dissolve much faster, from one and a half weeks to two months. Seams with vicryl threads disappear in 2-3 months. Do not confuse the timing of suture resorption with the timing of wound healing. For the latter, one and a half to two weeks is enough, while the sutures dissolve much later. If they are not made of threads, but in the form of metal brackets, then removal is indispensable. Typically, braces are removed 5-7 days after birth. You should not worry about the pain of this process; most often it causes nothing more than discomfort. The place where the stitches are placed can hurt much longer than the actual removal of the stitches after childbirth.

Complications of postpartum wounds

Alas, they also occur and the size of the seam is not the most important indicator here. The most common complication is suture dehiscence. Most often, this occurs with external seams, and the reasons for this may be the following:

  • sudden movements;
  • squats and premature landings;
  • inflammatory processes;
  • sex life.

If the stitches are placed on the perineum, then you cannot sit down fully in the first days. IN best case scenario you can sit on lateral surface thighs, in order to eliminate the load directly on the suture site. Ideally, it is best to either stand or lie down.

It is not difficult to understand that removal of stitches after childbirth will not be necessary, since the latter have come apart. The first sign of this phenomenon is a feeling of inflammation, bleeding or severe discomfort. It is not at all necessary that the sutures should “burst”; much more often there are situations where, due to the load experienced, they diverge slightly, this area becomes a gateway for infection, and then events develop more than typical. First, there is a feeling of distension in the area where the suture is applied, then inflammation is felt even on palpation, often painful; this process may be accompanied by an increase in temperature. In particularly aggravated cases, purulent discharge may be present, but for them to appear, you need to significantly improve your health. Therefore, if there are doubts about the quality of the seam, or unpleasant sensations in its area, you should not wait for discharge. A timely visit to a gynecologist will help to avoid many problems in the future, simplify treatment and get as close as possible to answering the question of how long it takes for sutures to dissolve after childbirth.

Caring for seams

In the conditions of the maternity hospital, it is fully entrusted to medical workers. The classic scheme is a daily examination, rinsing with antibacterial drugs, and treatment with wound-healing drugs. The most characteristic and frequently used among them is the common brilliant green. Sutures inside the uterus or vagina do not require special care, but compliance simple rules, relevant after childbirth, are only welcome. Therefore, to avoid infection, you should abstain from sexual activity until the discharge is over and the sutures are reabsorbed, do not expose them to excessive heat, and do not soak them. Therefore, you can forget about a bath for the next few weeks, just a shower. Special attention attention should be paid to nutrition, since in case of problems with stool, excessive impact on the damaged area is obvious. In order to prevent possible constipation, you need to plan the menu so that it does not contain an excess of flour products. But you should also be more careful with vegetables: an upset stomach in this situation is absolutely unnecessary.

Regardless of how long the sutures dissolve after childbirth, high-quality intimate hygiene is mandatory. It is advisable to wash your genitals after each visit to the toilet. There are no special requirements for the treatment of sutures after a cesarean section, since it is assumed that doctors discharge a woman from the maternity hospital only after they are finally convinced of the consistency of the suture and other indicators characterizing the patient’s normal recovery.

When does it stop hurting?

The scar after a cesarean section becomes barely noticeable almost half a year after the suture is applied. Before this, sensations of heaviness, spasms and “whining” in this area are quite possible. Sutures in the perineum do not require such a long recovery time, but here, too, much depends on the woman herself and on how strictly she follows the doctor’s recommendations. There are often situations when, even after the sutures have been absorbed, a certain dryness and tightness of the vagina is felt, which is most pronounced during lovemaking. Fear of pain can be a significant barrier, but two months after suturing, it is not only possible, but necessary to try. And it’s not so important how long the sutures dissolve after childbirth, much more recommendations are more important attending physician and self-confidence. Despite the fact that the mother’s body has undergone significant changes, this is not a reason to deny herself intimate relationships. Using lubricant or more will help smooth out the situation in the first days. careful attitude to a woman.

Any surgical intervention is a forced measure associated with varying degrees of trauma to body tissues. The recovery time of the body after surgery and the speed of healing of the sutures determine how quickly the patient can return to active life. Therefore, questions about how quickly the sutures will heal and how to avoid postoperative complications are so important. The speed of wound healing, the risk of complications and the appearance of the scar after surgery depend on the suture material and the method of suturing. We'll talk more about seams today in our article.

Types of suture materials and suturing methods in modern medicine

An ideal suture material should have the following characteristics:

Be smooth and glide without causing additional damage. Be elastic, stretchable, without causing compression and tissue necrosis. Be durable and withstand loads. Tie securely in knots. Be biocompatible with body tissues, inert (do not cause tissue irritation), and have low allergenicity. The material should not swell from moisture. The period of destruction (biodegradation) of absorbable materials must coincide with the time of wound healing.

Different suture materials have different qualities. Some of them are advantages, others are disadvantages of the material. For example, smooth threads will be difficult to tighten into a strong knot, and the use natural materials, so valued in other areas, is often associated with an increased risk of developing infections or allergies. Therefore, the search for the ideal material continues, and so far there are at least 30 thread options, the choice of which depends on specific needs.

Suture materials are divided into synthetic and natural, absorbable and non-absorbable. In addition, materials are manufactured consisting of one thread or several: monofilament or multifilament, twisted, braided, having various coatings.

Non-absorbable materials:

Natural - silk, cotton. Silk is a relatively durable material, thanks to its plasticity it ensures the reliability of knots. Silk is a conditionally non-absorbable material: over time, its strength decreases, and after about a year the material is absorbed. In addition, silk threads cause a pronounced immune response and can serve as a reservoir of infection in the wound. Cotton has low strength and is also capable of causing intense inflammatory reactions. Stainless steel threads are durable and produce minimal inflammatory reactions. Used in abdominal surgeries, when suturing the sternum and tendons. Synthetic non-absorbable materials have the best characteristics. They are more durable and their use causes minimal inflammation. Such threads are used to connect soft tissues, in cardiac and neurosurgery, and ophthalmology.

Absorbable materials:

Natural catgut. The disadvantages of the material include a pronounced tissue reaction, the risk of infection, insufficient strength, inconvenience in use, and the inability to predict the timing of resorption. Therefore, the material is currently practically not used. Synthetic absorbable materials. Made from degradable biopolymers. They are divided into mono and polyfilament. Much more reliable compared to catgut. They have certain resorption times, which differ for different materials, are quite durable, do not cause significant tissue reactions, and do not slip in the hands. Not used in neuro and cardiac surgery, ophthalmology, in situations where constant strength of sutures is required (for suturing tendons, coronary vessels).

Suture methods:

Ligature sutures - they are used to ligate vessels to ensure hemostasis. Primary sutures - allow you to compare the edges of the wound for healing by primary intention. Sutures can be continuous or interrupted. According to indications, immersed, purse-string and subcutaneous sutures can be applied. Secondary sutures - this method is used to strengthen primary sutures, to re-close a wound with a large number of granulations, in order to strengthen a wound that heals by secondary intention. Such sutures are called retention sutures and are used to unload the wound and reduce tissue tension. If the primary suture was applied in a continuous manner, interrupted sutures are used for the secondary suture, and vice versa.

How long do stitches take to heal?

Every surgeon strives to achieve wound healing by primary intention. In this case, tissue restoration takes place in as soon as possible, swelling is minimal, there is no suppuration, the amount of discharge from the wound is insignificant. Scarring with this type of healing is minimal. The process goes through 3 phases:

Inflammatory reaction (first 5 days), when leukocytes and macrophages migrate to the wound area, destroying microbes, foreign particles, and destroyed cells. During this period, the connection of the tissues has not reached sufficient strength, and they are held together by seams. The phase of migration and proliferation (up to the 14th day), when fibroblasts produce collagen and fibrin in the wound. Thanks to this, granulation tissue is formed from the 5th day, and the strength of fixation of the wound edges increases. Phase of maturation and restructuring (from the 14th day until complete healing). During this phase, collagen synthesis and connective tissue formation continues. Gradually, a scar forms at the site of the wound.

How long does it take for stitches to be removed?

When the wound has healed to the point that it no longer requires the support of non-absorbable sutures, they are removed. The procedure is carried out under sterile conditions. At the first stage, the wound is treated with an antiseptic, and hydrogen peroxide is used to remove crusts. Grasping the thread with surgical tweezers, cross it at the point where it enters the skin. Gently pull the thread from the opposite side.

Suture removal time depending on their location:

Sutures on the skin of the torso and limbs should be left in place for 7 to 10 days. Stitches on the face and neck are removed after 2-5 days. Retention sutures are left in place for 2-6 weeks.

Factors influencing the healing process

The speed of healing of sutures depends on many factors, which can be divided into several groups:

Features and nature of the wound. Definitely, wound healing after minor surgery will be faster than after laparotomy. The process of tissue restoration is lengthened in the case of suturing a wound after an injury, when there has been contamination, penetration of foreign bodies, and crushing of tissue. Location of the wound. Healing occurs best in areas with good blood supply and a thin layer of subcutaneous fat. Factors determined by the nature and quality of surgical care provided. In this case, the features of the incision, the quality of intraoperative hemostasis (stopping bleeding), the type of suture materials used, the choice of suturing method, compliance with aseptic rules, and much more are important. Factors related to the patient’s age, weight, and health status. Tissue repair is faster at a young age and in people with normal body weight. Chronic diseases, in particular diabetes mellitus and other endocrine disorders, oncopathology, and vascular diseases prolong the healing process and can provoke the development of complications. At risk are patients with foci of chronic infection, with reduced immunity, smokers, and HIV-infected people. Reasons related to caring for the postoperative wound and sutures, compliance with diet and drinking habits, physical activity of the patient in the postoperative period, following the surgeon’s recommendations, and taking medications.

How to properly care for seams

If the patient is in the hospital, a doctor or nurse will care for the sutures. At home, the patient should follow the doctor's recommendations for wound care. It is necessary to keep the wound clean, treat it daily with an antiseptic: a solution of iodine, potassium permanganate, brilliant green. If a bandage is applied, consult your doctor before removing it. Special medications can speed up healing. One of these products is contractubex gel, containing onion extract, allantoin, and heparin. It can be applied after epithelization of the wound.

For the speedy healing of postpartum sutures, strict adherence to hygiene rules is required:

  • washing hands thoroughly before using the toilet;
  • frequent change of gaskets;
  • daily change of linen and towels;
  • within a month, taking a bath should be replaced with a hygienic shower.

If there are external stitches on the perineum, in addition to careful hygiene, you need to take care of the dryness of the wound; for the first 2 weeks you should not sit on a hard surface, constipation should be avoided. It is recommended to lie on your side, sit on a circle or pillow. The doctor may recommend special exercises to improve blood supply to tissues and wound healing.

Healing of sutures after caesarean section

You will need to wear a postoperative bandage and maintain hygiene; after discharge, it is recommended to take a shower and wash the skin in the suture area twice a day with soap. At the end of the second week, you can use special ointments to restore the skin.

Healing of sutures after laparoscopy

Complications after laparoscopy are rare. To protect yourself, you should remain in bed for 24 hours after the intervention. At first, it is recommended to stick to a diet and give up alcohol. For body hygiene, a shower is used, and the suture area is treated with an antiseptic. The first 3 weeks limit physical activity.

Possible complications

The main complications during wound healing are pain, suppuration and insufficient sutures (dehiscence). Suppuration can develop due to the penetration of bacteria, fungi or viruses into the wound. Most often, infection is caused by bacteria. Therefore, after surgery, the surgeon often prescribes a course of antibiotics for prophylactic purposes. Postoperative suppuration requires identification of the pathogen and determination of its sensitivity to antibacterial agents. In addition to prescribing antibiotics, the wound may need to be opened and drained.

What to do if the seam comes apart?

Suture insufficiency is more often observed in elderly and debilitated patients. The most likely timing of complications is from 5 to 12 days after surgery. In such a situation, you should immediately seek medical help. The doctor will decide on further management of the wound: leave it open or re-suture the wound. In case of evisceration - penetration of an intestinal loop through a wound, emergency surgical intervention is required. This complication may occur due to bloating, severe coughing or vomiting.

What to do if the stitch hurts after surgery?

Pain in the suture area for a week after surgery can be considered normal. During the first few days, the surgeon may recommend taking a painkiller. Following the doctor’s recommendations will help reduce pain: limiting physical activity, wound care, wound hygiene. If the pain is intense or persists for a long time, you should consult a doctor, since pain may be a symptom of complications: inflammation, infection, formation of adhesions, hernia.

You can speed up wound healing by using folk remedies. For this purpose, herbal mixtures are used internally in the form of infusions, extracts, decoctions and local applications, herbal ointments, rubbing. Here are some of the folk remedies used:

Pain and itching in the suture area can be relieved with the help of herbal decoctions: chamomile, calendula, sage. Treatment of the wound with vegetable oils - sea buckthorn, tea tree, olive. The frequency of treatment is twice a day. Lubricating the scar with a cream containing calendula extract. Applying a cabbage leaf to the wound. The procedure has an anti-inflammatory and healing effect. The cabbage leaf must be clean; it must be doused with boiling water.

Before using herbal remedies, you should definitely consult a surgeon. He will help you choose individual treatment and give the necessary recommendations.

During childbirth, women often experience tearing of the uterus or vagina.

This requires stitches.

In order to avoid problems with these scars, you need to know how long it takes for sutures to dissolve after childbirth and how they need to be removed.

Let's consider this issue in more detail.

How long does it take for different types of sutures to heal after childbirth?

According to localization (place of application), the sutures are:

1. On the cervix. They are installed when the cervix is ​​damaged by a fetus that is too large.

2. Stitches in the vagina. They are applied in case of birth trauma or vaginal rupture of varying depths. Novocaine or lidocaine is used as anesthesia.

3. Sutures can be placed on the perineum if it is damaged during childbirth, as well as during a special incision by a doctor. There are three types of perineal injuries:

Type 1 (damage to the skin only);

type 2 (skin and muscle damage);

Type 3 (severe muscle damage, their rupture, which reaches the walls of the rectum).

Depending on the extent and type of perineal injury, doctors may use different types threads (nylon, silk or absorbable).

There are the following types of main threads for suturing:

1. Catgut is a completely absorbable material, the threads of which are separated on the seventh day. This seam disappears within the first month.

2. Vicryl. It is usually used for caesarean sections. It resolves in 60-70 days.

3. Maxon. It completely dissolves approximately 190 days after application.

How long does it take for external sutures to heal after childbirth?

Depending on the place of application, they are distinguished:

External seams;

Internal seams.

External sutures are usually placed on the perineum. They are quite problematic because they can provoke various kinds of complications in the form of suppuration, inflammation, infection, etc. To prevent this, a young mother should know how to properly care for stitches. Doctors should inform her about this upon discharge from the hospital.

The healing period of sutures in the perineum takes more than long time, rather than internal sutures on the uterus and vagina. In order for them to heal faster, it is recommended to observe bed rest, sexual rest (at least in the first two weeks), and also treat wounds with special antiseptics.

The healing process of this type of suture is complicated by postpartum discharge from the uterus, which is a hotbed for the development of infection. To eliminate the possibility of harmful bacteria entering the wound, you should adhere to the following rules:

1. Change your sanitary pad every two hours.

2. Treat the sutures in the first days after application with antiseptics (it is advisable that a gynecologist do this in the first days).

3. Using blotting movements, wipe the perineum with a sterile napkin. Cloth towels cannot be used for this purpose, otherwise germs may enter the wound.

4. Do not sit down after childbirth for ten days, so as not to provoke suture divergence.

5. For ten days after giving birth, you should refrain from eating flour products and cereals in order to make bowel movements as easy as possible and not cause constipation.

If the sutures in the perineum were made of non-absorbable material, they are usually removed on the tenth day after birth.

If the patient has absorbable materials applied, they do not require removal and will dissolve on their own after some time, but sometimes they also have to be removed mechanically (if complications arise).

How long does it take for sutures to heal after childbirth by caesarean section?

A caesarean section is a rather complex abdominal operation in which several layers of soft tissue are dissected. For their subsequent connection, strong threads are used (vicryl, dexon, monocryl, etc.).

Today, cesarean section is very common through a transverse incision of the uterus, the length of which is from 11 to 13 cm. This cavity provides every opportunity to minimize blood loss and rapid wound healing.

When using self-absorbable threads, the healing time of the suture will be from three weeks to one month, although sometimes this process takes longer.

The healing of sutures using synthetic materials is somewhat more problematic: they are removed on the seventh day after application, but complete healing of the wound takes three to four weeks.

In addition, the healing period will largely depend on the care of the suture, lifestyle and the woman’s compliance with all medical recommendations.

How to care for seams

How long it takes for the sutures to dissolve after childbirth largely depends on how well you care for your sutures. There are the following rules that doctors advise their patients to follow after suturing:

1. Wear loose underwear so that it does not squeeze the crotch anywhere. It is also desirable that it be made from natural materials (cotton).

Wearing shapewear is strictly prohibited, as it interferes with blood circulation in the pelvis. This in turn can cause swelling.

2. Lubricate external scars with antibacterial ointments and solutions.

3. It is advisable to sit down gradually and not make sudden movements.

4. Until the sutures are removed, any physical activity(lifting weights, playing sports, etc.).

5. You should defecate regularly, otherwise, when defecation is delayed, additional stress will be created in the abdominal muscles, which will only increase pain. To soften the process of defecation, it is allowed to use rectal suppositories (it is recommended to consult a doctor before using them).

6. You need to drink a spoonful every day vegetable oil. This will normalize stool and prevent constipation.

7. In the first week after suturing, you should not bend over.

8. In order not to provoke inflammation of the scars, you should not take a hot bath before removing the stitches. It is best to wash in the shower.

9. Do not apply hot or cold compresses to scars, as this can cause inflammation. It is also not recommended to self-medicate. All your actions must be coordinated with your doctor.

How long does it take for stitches to dissolve after childbirth: possible complications

Quite often after discharge (1-2 weeks), a woman begins to feel pain and discomfort in the suture area. It is very important to respond to such a symptom in a timely manner, otherwise the condition may worsen further.

Postpartum wounds can cause the following complications:

1. Pain. This symptom appears after every operation, and childbirth is no exception. As a medicinal treatment to relieve pain, you can use special ointments (Contractubex) and dry heating. Take stronger ones medicines It is possible only when the woman is not breastfeeding. Otherwise, she should not be prescribed most analgesics, as they may have a negative impact on the baby’s condition.

2. Seam divergence can occur during sudden movement or sports activities. In this case, it is recommended to urgently call a doctor, as blood will ooze from the wound. In addition, this condition is dangerous because infection can get into open muscle tissue, which can lead to inflammation, fever and increased body temperature.

3. Itching. Typically, this symptom does not indicate the presence of pathologies or infection in the wound. Quite the opposite - it signals a favorable healing process, so it should not cause concern in women.

To slightly reduce the severity of the itching, you should wash with warm water. It is not recommended to use any medications for itching.

4. Wound suppuration is one of the most dangerous complications. Its symptoms are:

Increased body temperature;

Malaise;

Weakness;

Appearance unpleasant odor from the seam;

The appearance of purulent discharge from the wound from dull yellow to dark brown;

Fever;

Pain throughout the suture area.

If the wound becomes suppurated, the woman is advised to consult a doctor as soon as possible. After the examination, the doctor will prescribe the necessary ointments and antibiotics. Most effective drugs To eliminate inflammation, the following ointments are used: Malavit, Levomekol, Vishnevsky.

It is important to know that severe suppuration of the wound is dangerous not only for the health of the mother, but also for the child, especially if the woman is breastfeeding the baby.

5. Opening of internal bleeding can occur if the rules of wearing loose underwear and sitting are violated during the first weeks after surgery. This condition is extremely dangerous and requires immediate medical attention.

Immediately before discharge, the attending doctor should tell you the approximate date for suture removal. If a woman stays in the hospital long enough, her stitches can be removed right there. If she is discharged home, she will need to come to the doctor again after some time.

When removing the stitches, the patient does not have to go back to the hospital, since this procedure takes no longer than forty minutes and if the scarring is good, the doctor will let the patient go home the same day.

It is important to know that even if the wound is in satisfactory condition after the stitches are removed, the woman is advised to be careful and avoid lifting heavy objects. She can return to her usual way of life no earlier than six months after the initial suturing.

Self-absorbable sutures are often used for surgical interventions, including after childbirth. To apply such sutures, various materials are used that dissolve on their own over a certain period of time (catgut, lavsan, vicryl).

When to apply self-absorbable sutures

information Self-absorbing sutures after childbirth are in most cases used for ruptures of the internal genital organs (vagina, cervix), because access to these organs is difficult and will be easier if there is no need to subsequently remove sutures there.

For ruptures and cuts in the perineum, various sutures can be applied: both self-absorbing ones and those requiring the removal of threads.

Suture dissolution time

The resorption time of sutures depends on the threads with which it was made:

  1. Catgut. The resorption time depends on the diameter of the thread and the place of its application and ranges from 30 to 120 days;
  2. Lavsan. There are threads with different resorption periods (from 10-12 days to 40-50 days);
  3. Vicryl(60-90 days).

Complications of postpartum wounds

The main complications of sutures in postpartum period are failure (divergence) of the sutures and their suppuration (infection).

Seam divergence

Insolvency internal seams(on the cervix and vagina) is extremely rare. Basically, the divergence of the external sutures applied to the perineum occurs.

The main reasons for the divergence of the wound on the perineum:

  • Early sitting down;
  • Sudden movements;
  • Sex life;
  • Suture infection.

Signs of seam dehiscence:

  • Pain in the wound area;
  • The appearance of wound bleeding;
  • Painful swelling;
  • Temperature rise(if infected);
  • Feeling of heaviness and fullness in the area of ​​the postoperative wound(indicates an accumulation of blood - a hematoma).

Wound infection

In most cases, wound infection occurs when personal hygiene rules are not followed and sutures are not properly cared for.

The main signs of purulent-inflammatory complications of sutures in the perineum are:

  1. High temperature;
  2. Hyperemia(redness) of the wound area;
  3. Soreness;
  4. The appearance of purulent discharge from the sutures.

At the first sign of complications, you should immediately contact your obstetrician-gynecologist for help. The doctor will carry out the necessary procedures and prescribe treatment.

Caring for stitches after childbirth

remember Sutures placed on the vagina and cervix do not require additional treatment: the woman just has to follow the rules of personal hygiene to prevent the development of purulent-inflammatory complications. Sutures in the perineum, on the contrary, require increased attention and careful adherence by the mother to all recommendations.

Precautions:

  • You should not sit for a week after giving birth(a longer time limit is possible). A woman is only allowed to lie down and stand. Then you can gradually sit down on a soft surface (pillow) with one buttock, and then with your whole buttock. Avoid sitting on hard surfaces for 3 weeks;
  • It is strictly forbidden to use shapewear, pressing on the perineum;
  • On the first day after childbirth, you should try to delay the act of defecation.: a woman should not eat a lot; be sure to avoid products that have a strengthening effect;
  • No early start. You should start having sex no earlier than 2 months after giving birth.

Seam processing technique:

  1. Treatment with antiseptic solution(in most cases brilliant green). In the maternity hospital, the sutures are processed by a midwife 1-2 times a day on a gynecological chair. At home, a woman should deal with the wound area independently with the help of relatives or go to see an obstetrician-gynecologist at the antenatal clinic every day for a week;
  2. Physiotherapy(ultraviolet irradiation of the wound). Continuation of the procedures is possible at home with the help of special lamps.

Maintaining personal hygiene:

  • Change sanitary pads at least every 2 hours;
  • Wear only loose underwear made from natural fabrics or special disposable panties;
  • Carry out genital hygiene with baby soap 2 times a day, after which thoroughly wipe the perineum with a clean towel and treat with an antiseptic solution;
  • Wash with warm water every 2 hours(it is possible to use medicinal herbs - calendula);
  • Wash your genitals after every visit to the toilet.

Stitches on the cervix are applied for cervical ruptures during examination of the birth canal, which is performed immediately after childbirth. Ruptures most often occur in typical places: at 3 and 9 “o’clock” (if the cervix, as is customary among obstetricians and gynecologists, is represented in the form of a clock dial). Suturing such ruptures does not require pain relief - after childbirth, the cervix is ​​insensitive to pain. The most commonly used absorbable suture material is biological material. catgut (made from the small intestine of cattle or sheep) or semi-synthetic threads: vicryl, PHA, caproag. Seams can be separate (a series of short threads, each of which is fixed with a knot) or continuous, where a knot is tied only at the beginning and end of a linear break. These sutures do not require special care in the postoperative period and do not cause concern.

Stitches in the vagina applied for ruptures of the vaginal wall. Absorbable materials are also used to place individual sutures or a continuous suture. This is a more painful operation that requires local anesthesia. (NOVOCAINE, LIDOCAINE) or general (short-term intravenous anesthesia). The seams do not require special care. Stitched vaginal tears may be mildly painful for a couple of days after they are repaired.

Stitches on the crotch are applied in case of ruptures of the perineum during childbirth or its artificial dissection.

There are three degrees of perineal ruptures (Fig. 1): I - rupture of only the skin of the posterior commissure of the vagina; II - rupture of the skin and muscles of the pelvic floor and III - rupture of the skin, muscles and wall of the rectum.

Perineotomy (Fig. 2a) is a dissection of the perineum along the midline from the posterior commissure of the vagina towards the anus. Episiotomy (Fig. 2b) is the same dissection, originating from the posterior commissure, but at an angle of approximately 45 °C to the right or left (usually to the right).

Perineal incision can be performed under local anesthesia NOVOCAINE or LIDOCAINE, or maybe without pain relief, given that there are numerous physiological mechanisms that protect the perineum from pain during childbirth. In a surgical sense, the incision has numerous advantages over a rupture of the perineum: the incision has smooth edges (and the scar, as a result, turns out to be more aesthetic), the incision is made to the desired depth and relatively rarely spontaneously extends to nearby organs.

Perineal tears are sutured in layers: first, the wall of the rectum is sutured with a special series of sutures (if, of course, this is required). Then, using absorbable suture material (catgut, vicryl, PHA) The muscles of the perineum are connected and only then the skin. The skin is usually sutured with non-absorbable material - silk, nylon or nikanta (nylon impregnated with antibiotic GENTAMICIN or TETRACYCLINE). The same principle is observed when restoring the integrity of the perineum after perineotomy or episiotomy.

Suture techniques. If the edges of the incision are sufficiently smooth, it is possible to apply a cosmetic intradermal suture. This suture came into surgery from cosmetology. The essence of the technique of its application is that the thread passes through the thickness of the skin in a zigzag manner, coming out only at the beginning and end of the incision. As a result, the scar is thinner and lacks such a specific affiliation. surgical suture, like marks from needle pricks and punctures accompanying a “regular” seam on both sides.

They also use a technique in which one thread stitches both muscles and skin at once. This technique allows for a good comparison of tissues, and the healing process is less painful. This suture is made with absorbable material.

Healing period. Healing a suture on the perineum is somewhat more problematic than sutures on the cervix and vagina. For good healing of any wound, several conditions are required, important among which are rest and asepsis (that is, maximum protection from pathogens). Several decades ago, after a rupture or incision of the perineum, patients were kept in bed for several days, which greatly contributed to the good healing of the wound. Currently, due to the widespread presence of mothers and babies together in the postpartum ward, ensuring complete rest of the perineum is problematic.

It can also be difficult to provide the aseptic conditions necessary for healing. Constant contact with postpartum discharge (lochia), as well as the inability to attach a sterile bandage to the wound, are factors that create some difficulties in the treatment of perineal wounds.

To help your body overcome these difficulties, you must first of all strictly monitor the cleanliness of the relevant area. Sanitary pads should be changed every 2 hours. In a hospital setting, the treatment of sutures with antiseptic solutions is usually carried out by staff on a gynecological chair or on a bed once a day. After each urination and defecation, it is necessary to wash with warm water or a weak solution of manganese, and then dry the seam area with a clean towel using blotting movements. This is recommended to be done both in the maternity hospital and at home for 1.5-2 months after birth.

If there are sutures on the perineum, mechanical sparing (rest) of the muscles and skin of the corresponding area is necessary. Despite the fact that complete immobilization of a postpartum woman, as a rule, is impossible, movements should be minimal and careful. A postpartum woman with stitches should not sit down for 10 days after birth; Failure to follow this recommendation may result in seams coming apart. For the convenience of young mothers, postpartum departments are equipped with “buffet” tables for eating while standing; you can eat while lying in bed, also on a special bedside table. For 2-3 days after childbirth, it is not recommended to eat bread and other products made from flour and cereals in order to delay the onset of stool as much as possible (although after an enema in the maternity ward there will be no stool for 2 or 3 days).

Sutures made of non-absorbable material are usually removed 6-7 days after their application. If the postpartum woman has already been discharged from the maternity hospital, the stitches are removed in the antenatal clinic. This is a simple and painless procedure. But even after this, it is necessary to continue to strictly observe the rules of hygiene. Only no earlier than 10 days after birth can a woman in labor sit, first on a hard chair and only then on soft sofas and armchairs.

The trip home from the maternity hospital will be associated with certain difficulties. To avoid trouble, you should take a reclining position in the back seat of the car. Warn relatives that, in addition to the young parents and the baby, only one person can ride in the car, because only the front seat will be free.

Sutures after caesarean section

Caesarean section is an extensive abdominal operation, during which many different soft tissues are dissected, which are sequentially connected with sutures.

Suture on the uterus. Suturing the uterus - important stage Caesarean section operations. Currently, the most common caesarean section in the lower segment of the uterus is a transverse incision. The length of the incision is 11 -12 cm. This incision creates optimal conditions for healing the wound on the uterus and minimizes surgical blood loss, but if for some reason this particular direction of the incision is difficult, a “classical” or “corporal” cesarean section is performed with a longitudinal incision the body of the uterus is the same length.

Over the years of the development of obstetric science, a great many opinions have been expressed about what and how the uterus should be sutured in order to create optimal conditions for carrying subsequent pregnancies. Now the uterus is most often sutured with a single-row or double-row continuous suture using absorbable materials with a long period of complete absorption (i.e. actual resorption) - 70-120 days (Vicryl, Monocryl, Dexon, Caproag). Sometimes special individual sutures are used. However, any of these methods, when carefully implemented, gives excellent results, and preference in practice, as a rule, is given to the method that is most proven in a particular obstetric institution.

IN recent years In domestic clinics, uterine dissection is increasingly being used using an American device from the company "Auto Suite" (“AutoSuture”). Using this device, an incision is made in the uterus with simultaneous application of staples made of absorbable material to the edges of the wound, which can significantly reduce the amount of blood loss.

After suturing the wound on the uterus and revision of the abdominal organs, the peritoneal cover, muscles of the anterior abdominal wall, tendons and subcutaneous fat are sequentially sutured. For this purpose, absorbable semi-synthetic threads or regular catgut are used.

Stitches on the skin. The choice of method for suturing a skin wound after a cesarean section depends on the direction of the skin incision. There are quite a few surgical approaches for caesarean section, but in modern obstetrics the three most common types of skin incisions are:

  • Inferomedian laparotomy (dissection of the anterior abdominal wall). The incision is made vertically, along the midline between the pubis and the navel, 12-15 cm long (Fig. 3a). Its main advantage is speed and convenience, so this type of skin incision is almost always used in emergency situations, when a few minutes can be decisive (for example, in case of massive bleeding).
  • Laparotomy according to Joel-Cohen. A transverse incision is made 2-3 cm below the middle of the distance between the pubis and the navel. This is a convenient and fairly quick surgical access for caesarean section.
  • Laparotomy according to Pfannenstiel. An arcuate transverse incision is made along the suprapubic skin fold (Fig. 3b). It is this circumstance - the best cosmetic effect - that determines the widespread use of this type of intervention. Being in a skin fold, a thin skin scar merges with it and sometimes becomes completely difficult to distinguish. In addition, both transverse incisions create favorable conditions for applying an intradermal suture, which we discussed above. The longitudinal incision is always sutured with separate silk (or other non-absorbable material) sutures, because in this case the sutures are under conditions of greater mechanical stress; Accordingly, higher demands are placed on the mechanical strength of the skin suture.

Healing period. The first one or two days after surgery, the suture area is quite painful and requires medical anesthesia. The source of pain, of course, is not only the skin wound - pain is caused by all soft tissues intersected during surgery. Despite this, getting up early (one day after surgery) is very useful. Sometimes, especially with developed subcutaneous tissue of the abdomen, relief comes from wearing a postpartum bandage, which limits the mobility of the soft tissues of the abdomen and thereby provides more complete rest to the skin wound.

Sutures on the skin are treated with antiseptic solutions every other day or every day, applying a sealed sterile bandage. Self-adhesive bandages sold in pharmacies are very convenient. If the sutures are silk, they are removed on the 7th day, before discharge.

After discharge, there is usually no need to independently care for skin sutures - general hygiene measures are sufficient. The seam can be washed with soap and water, only refraining from applying strong pressure and using hard sponges and washcloths.

Absorbable materials have different mechanisms of resorption, they lose strength in different ways, and dissolve after different amounts of time. This may determine the characteristics of the postpartum period.

Thus, threads of natural origin are dissolved under the influence of enzymes produced in the liver, which is accompanied by a pronounced reaction of the surrounding tissues - redness may occur, and clear discharge leaks from the injection sites. Since catgut is a natural biological material, it can cause allergic reactions. This circumstance makes healing difficult, and the sutures may come apart.

Synthetic threads (vicryl, PDS) dissolve as a result of hydrolysis, i.e. dissolve under the influence of body fluids when water penetrates the fibers of the thread. Compared to the mechanism of resorption of natural threads, hydrolysis causes a less pronounced reaction of the body. The average time for resorption of suture material is:

  • Catgut completely resolves within 30 days, but loses strength after 7 days, that is, if there are catgut sutures on the perineum, the “threads” separate on the 7th day.
  • Vicryl completely resorbs in 60-90 days. This material is widely used during caesarean sections.
  • PDS (maxon) completely resolves by day 210. PDS is used to connect tendons after a cesarean section.

In conclusion, we cannot help but say a few words about the psychological consequences of birth trauma and cesarean section. It would seem difficult to find a young woman who is completely indifferent to the appearance of scars on her body. However, none of the serious researchers dealing with the psychological problems of postpartum women names the presence of a skin scar among the significant reasons for negative emotions in the postpartum period. For example, young mothers after a caesarean section are much more concerned about the fact that their husband saw the child before she did, rather than the presence of some kind of skin scar. Let stitches and scars remain an insignificant episode in the history of your childbirth. And doctors and modern medical technologies will help you with this.