LEARNING GUIDE 45 REPAIR OF CERVICAL TEARS (TO BE

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LEARNING GUIDE FOR AUGMENTATION OF LABOR

LEARNING GUIDE 4.5: REPAIR OF CERVICAL TEARS

(To be completed by Learners)

Rate the performance of each step or task observed using the following rating scale:

1 Needs Improvement: Step or task not performed correctly or out of sequence (if necessary) or is omitted

2 Competently Performed: Step or task performed correctly in proper sequence (if necessary) but learner does not progress from step to step efficiently

3 Proficiently Performed: Step or task efficiently and precisely performed in the proper sequence (if necessary)

LEARNING GUIDE FOR REPAIR OF CERVICAL TEARS (Many of the following steps/tasks should be performed simultaneously.)
STEP/TASK	CASES
GETTING READY Note: Learners should use this learning guide in conjunction with Learning Guide 4.4: Vaginal and Cervical Inspection.
Prepare the necessary equipment.
Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
Provide continual emotional support and reassurance, as feasible.
Have the woman empty her bladder or insert a catheter, if necessary.
Give anesthesia (IV pethidine and diazepam, or ketamine), if necessary.
Put on personal protective barriers.
REPAIR OF CERVICAL TEARS
Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.
Put high-level disinfected or sterile surgical gloves on both hands.
Have an assistant shine a light into the vagina.
Clean the vagina and cervix with antiseptic solution.
Have the assistant massage the uterus and provide fundal pressure.
Insert a ring or sponge forceps into the vagina and grasp the cervix on one side of the tear.
Insert a second ring or sponge forceps and grasp the cervix on other side of the tear.
Place the handles of both forceps in one hand: Hold the cervix steady by gently pulling the forceps toward you.
Place the first suture at the top (the apex) of the tear.
Close the tear with a continuous suture: Be sure to include the whole thickness of the cervix each time the suture needle is inserted.
If a long section of the rim of the cervix is tattered, under-run it with a continuous suture.
If the apex is difficult to reach and ligate: Grasp it with artery or ring forceps. Leave the forceps in place for 4 hours. After 4 hours, open the forceps partially but do not remove. After another 4 hours, remove the forceps completely.
POSTPROCEDURE TASKS
Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
Place all instruments in 0.5% chlorine solution for 10 minutes for decontamination.
Immerse both gloved hands in 0.5% chlorine solution. Remove gloves by turning them inside out. If disposing of gloves, place them in a leakproof container or plastic bag. If reusing surgical gloves, submerge them in 0.5% chlorine solution for 10 minutes for decontamination.
Wash hands thoroughly with soap and water and dry with a clean, dry cloth or air dry.

CHECKLIST 4.5: REPAIR OF CERVICAL TEARS

(To be used by the Learner for practice and by the Teacher at the end of the module)

Place a “” in case box if step/task is performed satisfactorily, an “X” if it is not performed satisfactorily, or N/O if not observed.

Satisfactory: Performs the step or task according to the standard procedure or guidelines

Unsatisfactory: Unable to perform the step or task according to the standard procedure or guidelines

Not Observed: Step or task not performed by learner during evaluation by teacher

LEARNER ______________________________________ Date Observed______________

CHECKLIST FOR REPAIR OF CERVICAL TEARS (Many of the following steps/tasks should be performed simultaneously.)
STEP/TASK	CASES
GETTING READY
Prepare the necessary equipment.
Tell the woman (and her support person) what is going to be done, listen to her and respond attentively to her questions and concerns.
Provide continual emotional support and reassurance, as feasible.
Have the woman empty her bladder or insert a catheter.
Give anesthesia, if necessary.
Put on personal protective barriers.
SKILL/ACTIVITY PERFORMED SATISFACTORILY
REPAIR OF CERVICAL TEARS
Wash hands thoroughly and put on high-level disinfected or sterile surgical gloves.
Clean the vagina and cervix with an antiseptic solution.
Grasp both sides of the cervix using ring or sponge forceps (one forceps for each side of tear).
Place the first suture at the top of the tear and close it with a continuous suture, including the whole thickness of the cervix each time the suture needle is inserted.
If a long section of the rim of the cervix is tattered, under-run it with a continuous suture.
Use ring forceps if the apex is difficult to reach and ligate.
SKILL/ACTIVITY PERFORMED SATISFACTORILY
POSTPROCEDURE TASKS
Before removing gloves, dispose of waste materials in a leakproof container or plastic bag.
Place all instruments in 0.5% chlorine solution for decontamination.
Remove gloves and discard them in a leakproof container or plastic bag if disposing of or decontaminate in 0.5% chlorine solution them if reusing.
Wash hands thoroughly.
SKILL/ACTIVITY PERFORMED SATISFACTORILY

MCPC Learning Resource Package Module 4, Vaginal Bleeding after Childbirth – Page 39

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LEARNING GUIDE 45 REPAIR OF CERVICAL TEARS (TO BE

LEARNING GUIDE FOR AUGMENTATION OF LABOR

CASES