A case report of successful vaginal delivery in a patient with severe uterine prolapse and a review of the healing process of a cervical incision

Abstract

Background: The incidence of severe uterine prolapse during childbirth is approximately 0.01%. Moreover, to the best of our knowledge, no reports detail the healing process of the cervix during uterine involution. This report describes successful vaginal delivery and the healing process of postpartum uterine prolapse and cervical tears in a patient with severe uterine prolapse.

Case presentation: A patient in her 40s (gravida 3, para 1, abortus 1) with severe uterine prolapse successfully delivered a live female baby weighing 3190 g at 38 + 5 weeks of gestation by assisted vaginal delivery. Uterine prolapse had improved to approximately 2° by 2 months postoperatively. On postpartum day 4, during the healing process of cervical laceration, the thread loosened in a single layer of continuous sutures due to uterine involution, and poor wound healing was observed. The wound was subsequently re-sutured with a two-layer single ligation suture (Gambee suture + vertical mattress suture). However, on postpartum day 11, a large thread ball was hindering the healing of the muscle layer, which improved with re-suturing.

Conclusion: Although vaginal delivery in a patient with severe uterine prolapse is possible in some cases, the cervix should be sutured, while considering cervical involution after delivery.

Keywords: Complete uterine prolapse; Pregnancy; Scars; Suture techniques; Vaginal delivery.

Fig. 1

Photographs at the onset of uterine prolapse at 36 weeks of gestation.

Fig. 2

Cervical edema and cervical length of 8.8 cm, color Doppler with 3D transvaginal ultrasonography. A, Sagittal section; B, Coronal section; C, Transverse section; D, Color Doppler.

Fig. 3

Healing process of cervical laceration and cervical canal prolapse. A: Cervical laceration suture surface on the day of delivery. B: On postpartum day 4, suture failure was noted due to a continuous 1-layer suture (0 mesh thread (Vicryl®), absorbable thread). C: On postpartum day 4, stitches were removed and debridement was performed. D: On postpartum day 4, re-suture and first-layer Gambee suture (2–0 mesh thread, absorbable (Vicryl®)) were performed. E: On postpartum day 4, re-suture and second-layer horizontal mattress suture (2–0 mesh thread, absorbable (Vicryl®)) were performed. F: On postpartum day 11, the thread had formed into a ball, which interfered with viability. The wound was re-sutured using a single ligation due to suture failure (3–0 mesh thread, absorbable (Vicryl®)). G: On postpartum day 28, uterine prolapse improved to 2°–3°, and the wound became viable.