Rupture of the posterior cul-de-sac during trial of labour after caesarean section

Abstract

Rupture of the vaginal wall in unobstructed labour is a rare entity in the developed world. This case report describes rupture of the posterior cul-de-sac in a healthy 34-year-old multiparous woman attempting trial of labour after caesarean section. The woman presented to the labour ward at term with spontaneous onset of contractions. In the second stage of labour, the woman experienced sudden severe abdominal pain, different in character from the contraction pain. Therefore, the baby was delivered by ventouse extraction. As the woman continued to experience severe immobilising abdominal pain during the hospital stay, a CT scan was performed which revealed a haematoma and free fluid at the right side of the uterus. A laparotomy was performed 3 days postdelivery, during which a rupture of the posterior cul-de-sac was found and closed with a continuous suture. The woman was discharged 3 days after laparotomy in good clinical condition.

Keywords: obstetrics and gynaecology; pregnancy.

Figure 1

Abdominal CT image with intravenous contrast. (A) Axial CT image: evidence of an organised haematoma (indicated by an arrow) on the dorsal side of the uterus, surrounded by a minimal amount of free fluid. (B) Coronal CT image: no signs of active bleeding. The myometrium on the right lateral side of the uterus does not light up during the arterial or venous phase (indicated by an arrowhead). The collection of fluid on the dorsolateral side of the uterus has a close relationship with the myometrium possibly indicating a uterine rupture (indicated by an asterisk).