An intrapartum cervical buttonhole tear: A case report and review of rare tear pathogenesis

Genital tract trauma and obstetric anal sphincter injuries are known complications of normal vaginal and assisted vaginal delivery. Cervical tears are an uncommon complication that can lead to significant postpartum haemorrhage and may have implications for future pregnancies. Careful evaluation of the genital tract, including the cervix, along with adequate resuscitation are essential to reduce maternal morbidity and mortality. This is a case report of a 36-year-old primigravida woman at 41 + 6 weeks of gestation with delay in the second stage requiring Neville Barnes forceps delivery. She then went on to have a major postpartum haemorrhage, initially thought to be a result of uterine atony. However, inadequate response to uterotonics led to identification of a cervical buttonhole tear with an intact external os. She required repair under general anaesthesia. A rigid sigmoidoscope was utilised to ensure cervical canal patency during the repair. Previous reports have described annular cervical tears, thought to occur from the extension of a cervical buttonhole tear, but to the best of our knowledge the latter has not previously been reported. The case demonstrates the importance of awareness of such tears and proposes a novel technique for repair with the use of a rigid sigmoidoscope.