During childbirth, the cervix may tear unilaterally, bilaterally, or in a stellate pattern, with varying degrees of severity ranging from grade I to tears extending to the fornix. If surgical repair is not performed promptly, subsequent scar tissue contraction can cause cervical eversion, exposing the cervical mucosa externally and resulting in cervical ectropion.

bubble_chart Clinical Manifestations

Grade I cervical ectropion has no obvious symptoms, and there may be a slight increase in mucus-like leucorrhea. However, when combined with infection and the formation of chronic uterine cervicitis, it turns into mucopurulent discharge with increased volume, and contact bleeding may occur. Other symptoms of chronic uterine cervicitis may also be present.

Vaginal speculum examination: The uterine cervix appears as a transverse fissure or star-shaped, with a noticeable distance between the anterior and posterior lips of the cervix. The mucosal folds at the lower end of the cervical canal can be observed. If concurrent with uterine cervicitis, long-term congestion, edema, and connective tissue proliferation may cause significant hypertrophy of the anterior and posterior lips of the cervix, with red and swollen mucosa and a surface covered with mucoid secretions (Figure 1).

Figure 1: Cervical ectropion (with laceration on the left side)

Vaginal digital examination: The external os of the cervix is relatively wide, and sometimes the longitudinal folds along the midline of the cervical canal can be palpated.

bubble_chart Diagnosis

Cervical ectropion of the uterus usually involves scar tissue from cervical lacerations and deeper tears at the external cervical os, where the folds of the cervical canal can be seen or felt. Applying a 3% acetic acid solution to the affected area may reveal uniform grape-like or noodle-like protrusions.

For grade I uterine cervical ectropion without clinical symptoms, no treatment is necessary. If accompanied by symptoms of chronic cervicitis, treatment should be administered according to the principles for managing chronic cervicitis.

bubble_chart Prevention

In addition to paying attention to mastering the techniques of artificial late abortion and correctly handling the induction of intermediate-stage [second-stage] pregnancy and childbirth, routine examination of the cervix should also be performed during postpartum and post-late abortion follow-ups. If severe cervical lacerations are found, timely repair is advisable.

bubble_chart Differentiation

It can be differentiated from cervical erosion of the uterus (the latter appears as a uniform milky white, occasionally interspersed with grape-like protrusions), and the colposcopic findings are also different. For details, refer to the colposcopy section in the chapter on special gynecological examinations.

Cervical ectropion and hypertrophy of the uterus may sometimes be difficult to distinguish from early cervical carcinoma in appearance. Routine vaginal cytology and colposcopy should be performed, and if necessary, a biopsy should be done for definitive diagnosis. For cases that still cannot be confirmed, regular follow-up is recommended.