Spontaneous intrapartum Posterior Cul-de-sac rupture: A case report and literature review

INTRODUCTION: 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. CASE PRESENTATION: 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. CLINICAL DISCUSSION: 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. CONCLUSION: 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.