Intrapartal uterine avulsion with posterior cervical rupture

Abstract

In this case study we describe an obstetric emergency of complete intrapartum left-lateral uterine avulsion, with posterior cervical rupture in a 31-year-old secundipara, following vacuum extraction. To the best of our knowledge, a similar case has not been previously reported in the literature. A live macrosomic male neonate was delivered by two tractions, with lateral episiotomy, and with shoulder dystocia that was relieved by McRoberts' and Resnik's maneuvers (Apgar score 7.8, birth weight/length 4640/57).In our patient, the risk factors for avulsion and concomitant posterior cervical rupture included prolonged second stage of labor, delivering a macrosomic neonate in a secundipara with deflexion (parietal) in a cephalic presentation along the distended and thinned posterior uterine wall. Urgent total hysterectomy was performed in dramatical circumstances due to complete unilateral avulsion and cervical rupture, with continuous aortal compression, volume replacement and intact coagulation, which certainly contributed to the good final maternal outcome.

Cervical avulsion during induced labour: diagnosis, intraoperative management and postoperative course

“…In this report, the damage was considered too great for surgical repair, and a hysterectomy was performed. 1 Similar extensions between the cervical avulsion and the intraabdominal anatomic structures also occurred in our case, but we elected conservative surgical management rather than hysterectomy. We would submit that cervical avulsions should hence cause concern for additional, internal injuries that cannot be easily diagnosed via vaginal or abdominal examination.…”

“…4 5 Concerningly, a report from Croatia detailed a case where cervical and internal tearing was diagnosed only at laparotomy. 1 In this case, an infant was delivered via ventouse with maternal haemorrhagic shock occurring postpartum. A posterior cervical rupture was noted in this case only once laparotomy was performed, with internal extension of the transverse cervical tear cephalad which separated the uterus from the sidewall and interrupted the uterine artery.…”