Abbas Riam, Nahhat Fouad, Balouli Maram, Alsaeed Heba, Kurdi Bashar
University Hospital of Obstetrics and Gynecology, Damascus, Syria.
Faculty of Medicine, Damascus University, Damascus, Syria.
Ann Med Surg (Lond). 2022 Sep 13;82:104572. doi: 10.1016/j.amsu.2022.104572. eCollection 2022 Oct.
Posterior Cul-de-sac rupture is a rare delivery complication and a diagnostic challenge to every obstetrician. The associated predisposing factors include genital anomalies (such as vaginal atresia), the use of misoprostol to induce delivery, previous pelvic infection, and caesarean scar. Herein, we report the case of a posterior Cul-de-sac rupture without any disposing risk factor.
A 27-year-old G5P4 pregnant woman at the 33rd week of gestation presented with spontaneous onset of labor, the administration of calcium channel blockers failed to stop her active labor, which progressed with a spontaneous rupture of membranes. The fetal heart rate decelerated suddenly to 40 beats per minute. Therefore, an emergency lower transverse cesarean section was performed. During the operation, a transverse 6 cm tear in the posterior vaginal wall was found. The ruptured vagina was sutured and the patient was discharged two days later in a good condition.
Posterior Cul-de-sac rupture might happen without any predisposing risk factors. Also, the vague and unspecific symptoms -mainly, sudden abdominal pain-can delay the diagnosis of such an entity.
we recommend keeping a high level of suspicion for a concealed vaginal wall rupture even in the absence of any predisposing factors, when sudden severe pain during labour cannot be otherwise explained.
直肠子宫陷凹后部破裂是一种罕见的分娩并发症，对每位产科医生来说都是一项诊断挑战。相关的诱发因素包括生殖器异常（如阴道闭锁）、使用米索前列醇引产、既往盆腔感染和剖宫产瘢痕。在此，我们报告一例无任何诱发危险因素的直肠子宫陷凹后部破裂病例。
一名27岁、孕5产4的孕妇，妊娠33周时出现自然临产，使用钙通道阻滞剂未能阻止其进入活跃期分娩，随后胎膜自然破裂。胎儿心率突然降至每分钟40次。因此，急诊行低位横切口剖宫产术。术中发现阴道后壁有一6厘米的横向撕裂伤。对破裂的阴道进行了缝合，患者术后两天情况良好出院。
直肠子宫陷凹后部破裂可能在没有任何诱发危险因素的情况下发生。此外，模糊且不具特异性的症状——主要是突发腹痛——可能会延误对此类病症的诊断。
我们建议，即使在没有任何诱发因素的情况下，当分娩时突然出现的剧痛无法用其他原因解释时，也要高度怀疑隐匿性阴道壁破裂。
