Anterior vaginotomy: abdominal delivery without a uterine incision.

To determine whether planned anterior vaginotomy is a logical and safe means of avoiding a uterine scar with term abdominal delivery. I recorded the complications of the technique and whether vaginal birth after anterior vaginotomy occurred. Thirteen anterior vaginotomies were done when the vagina had advanced during prolonged second stage. The procedure appears safe, although one patient had a postpartum bladder flap hematoma and one had gross hematuria postpartum. Three had postpartum endometritis and one was given a blood transfusion. In the six with records of follow-up pregnancies, two had elective cesareans, four attempted vaginal birth after vaginotomy with two failures (delivered by cesarean). The two successful procedures were uncomplicated. I conclude that unintended anterior vaginotomy should be coded. Such coding and analysis are required before it can be recommended that anterior vaginotomy replace cesarean after considerable vaginal advancement occurs. Vaginal advancement (and cervical retraction) during the second stage of labor requires further study.