Background: Complete separation of the vaginal vault from the uterus is a rare complication of cesarean delivery, requiring assistance with a vaginal hand. Case: A 24-year-old nulliparous woman at 40 weeks plus 3 days of gestation experienced arrest of the second stage of labor, and a vaginal hand was required during cesarean delivery to disimpact a deeply engaged fetal head. Results: Following delivery, complete detachment of the vaginal vault from the cervix was noted without disruption of the uterine vessels. Normal anatomy was surgically restored without complications. The neonate was treated for respiratory distress, and examined for sepsis and hyperbilirubinemia, requiring phototherapy. He was discharged 6 days and was healthy at a 2-week follow-up. Conclusions: Complete separation of the uterus and vaginal vault is a previously unknown complication resulting from elevation of an impacted fetal head vaginally. Simple reattachment of the uterus to the vaginal cuff represents a reasonable alternative to peripartum hysterectomy. (J GYNECOL SURG 29:93)
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References
1.
BergholtT, StenderupJK, Vedsted-JakobsenA, HelmP, LenstrupC. Intraoperative surgical complication during cesarean section: An observational study of the incidence and risk factors. Acta Obstet Gynecol Scand, 2003; 82:251.
2.
ChopraS, BaggaR, KeepanasserilA, JainV, KalraJ, SuriV. Disengagement of the deeply engaged fetal head during cesarean section in advanced labor: Conventional method versus reverse breech extraction. Acta Obstet Gynecol Scand, 2009; 88:1163.
3.
FasubaaOB, EzechiOC, OrjiEOet al.Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: A randomized comparative study of the two methods. J Obstet Gynaecol, 2002; 22:375.
4.
RahnDD, RuffMD, BrownSA, TibbalsHF, WordRA. Biomechanical properties of the vaginal wall: effect of pregnancy, elastic fiber deficiency, and pelvic organ prolapse. Am J Obstet Gynecol, 2008; 198:590.e1–6.
5.
LowderJL, DebesKM, MoonDK, HowdenN, AbramowitchSD, MoalliPA. Biomechanical adaptations of the rat vagina and supportive tissues in pregnancy to accommodate delivery. Obstet Gynecol, 2007; 109:136.
6.
GienLT, CovensA. Fertility-sparing options for early stage cervical cancer. Gynecol Oncol, 2010; 117:350.
7.
SzillerI, HupucziP, PappZ. Hypogastric artery ligation for severe hemorrhage in obstetric patients. J Perinat Med, 2007; 35:187.
