The Iranian Journal of Obstetrics, Gynecology and Infertility

The Iranian Journal of Obstetrics, Gynecology and Infertility

Rupture of posterior cul-de-sac: a rare complication following cesarean in low station of fetal head: a case report

Document Type : Case report

Authors
Seyedeh Houra Vahedalain 1
Malihe Afiat 1
Seyed Mostafa Pashang 2
1 Assistant professor, Department of Obstetrics and Gynecology, Women's Health Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 Anesthesiologist, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
10.22038/ijogi.2015.6442
Abstract
Introduction: Fetal extraction difficulty during cesarean delivery occurs in 1 to 2% of cases that one of the causes is impacted fetal head in delivery canal which is associated with many fetal and maternal complications. In this report, we introduce a 26 years old woman who is complicated with rupture of posterior cul-de-sac during cesarean in low station of fetal head which is a rare complication.
Case presentation: A 26 years old woman with first pregnancy at term presented to the hospital with labor pain in active phase of labor. In the second stage of labor, she was transferred to operative room for cesarean section due to prolonged deceleration of fetal heart rate (FHR). Because of impacted fetal head in delivery canal, the assistant placed her hand into the vagina to push the fetal head up into the uterus in order to surgeon can extract the fetus (abdominovaginal method). But this method was unsuccessful and fetus was extracted with reverse breech extraction method. Then we noticed rupture of posterior cul-de-sac in length 4-cm and it was repaired and the abdomen was closed. Patient was discharged after 72 hours with good condition and no signs and symptoms of infection.
Conclusion: Damage to the adjacent tissues and ligaments of the uterus is mentioned as a complication of performing cesarean in low station that the surgeon should pay special attention to these complications when repairing the caesarean site in cases of low station.
Keywords
Abdominovaginal method
Low station
Reverse breech extraction method
Rupture of posterior cul-de-sac
Second stage of labor
  1. Levy R, Chernomoretz T, Appelman Z, Levin D, Or Y, Hagay ZJ. Head pushing versus reverse breech extraction in cases of impacted fetal head during Cesarean section. Eur J Obstet Gynecol Reprod Biol 2005; 121(1):24-6.
  2. Blickstein I. Difficult delivery of the impacted fetal head during cesarean section: intraoperative disengagement dystocia. J Perinat Med 2004; 32(6):465-9.
  3. Sung JF, Daniels KI, Brodzinsky L, El-Sayed YY, Caughey AB, Lyell DJ. Cesarean delivery outcomes after a prolonged second stage of labor. Am J Obstet Gynecol 2007; 197(3):306.e1-5.
  4. Tan EK. Difficult caesarean delivery of an impacted head and neonatal skull fracture: can the morbidity be avoided? J Obstet Gynaecol 2007; 27(4):427-8.
  5. Young B, Takoudes T, Lim KH, Rana S. Rupture of the posterior cul-de-sac during spontaneous labor. Obstet Gynecol 2010; 115(2 Pt 2):414–7.
  6. Cetinkaya M, Kokcu A, Alpeer T. The rupture through posterior vaginal fornix of the posterior lower uterine segmet. J Matern Fetal Neonatal Med 2004; 16(5):295-6.
  7. Lask S. Perforation of the posterior fornix and pouch of Douglas during coitus. Br Med J 1948; 1(4555):786.
  8. Symmond RE, Couanseller VS, Pratt JH. Prolapse of a fallopian tube as a complication of hysterectomy; report of three cases. Am J Obstet Gyneco 1957; 74(1):214-7.
  9. Landesman R, Graber EA. Abdominovaginal delivery: modification of the cesarean section operation to facilitate delivery of the impacted head. Am J Obstet Gynecol 1984; 148(6):707-10.
  10. Lippert TH. Abdominovaginal delivery in case of impacted head in cesarean section operation. Am J Obstet Gynecol 1985; 151(5):703.
  11. Lippert TH. Bimanual delivery of the fetal head at cesarean section with the fetal head in midcavity. Arch Gynecol 1983; 234(1):59-60.
  12. Fong YF, Arulkumaran S. Breech extraction--an alternative method of delivering a deeply engaged head at cesarean section. Int J Gynaecol Obstet 1997; 56(2):183-4.
  13. Chopra S, Bagga R, Keepanasseril A, Jain V, Kalra J, Suri V. 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(10):1163-6.
  14. Berhan Y, Berhan A. A meta-analysis of reverse breech extraction to deliver a deeply impacted head during cesarean delivery. Int J Gynaecol Obstet 2014; 124(2):99-105.
  15. Fasubaa OB, Ezechi OC, Orji EO, Ogunniyi SO, Akindele ST, Loto OM, et al. Delivery of the impacted head of the fetus at caesarean section after prolonged obstructed labour: a randomized comparative study of two methods. J Obstet Gynaecol 2002; 22(4):375-8.
  16. Hadar E, Melamed N, Tzadikevitch-Geffen K, Yogev Y. Timing and risk factors of maternal complications of cesarean section. Arch Gynecol Obstet 2011; 283(4):735–41.
  17. Vahid Dastjerdi M. A survey of indications, outcomes and complications of caesarean section. Tehran Univ Med J 1998; 56(1):42-5. (Persian).
  18. van Ham MA, van Dongen PW, Mulder J. Maternal consequences of caesarean section. A retrospective study of intra-operative and postoperative maternal complications of caesarean section during a 10-year period. Eur J Obstet Gynecol Reprod Biol 1997; 74(1):1-6.
  19. Glance LG, Dick AW, Glantz JC, Wissler RN, Qian F, Marroquin BM, et al. Rates of major obstetrical complications vary almost fivefold among US hospitals. Health Aff (Millwood) 2014; 33(8):1330-6.
  20. Alexander JM, Leveno KJ, Rouse DJ, Landon MB, Gilbert S, Spong CY, et al. Comparison of maternal and infant outcomes from primary cesarean delivery during the second compared with first stage of labor. Obstet Gynecol 2007; 109(4):917-21.