Spontaneous rupture of the lower uterine segment and posterior vaginal fornix during labor in term pregnant women caused by cervical fibroids: a case report and review of the literature

Abstract

Abstract Background Uterine rupture during labor is a rare but serious complication that often leads to severe maternal and perinatal complications and even maternal death and stillbirth. Case introduction The patient was a 40-year-old multiparous woman at 40 weeks’ gestation with a singleton pregnancy. The obstetric examination showed that the cervical tube was 2cm long and hard. Eleven hours after admission, the patient felt abdominal pain suddenly aggravated and had bright red vaginal bleeding. The obstetric examination showed that the cervical opening was not opened, there was a rupture of about 4 cm in diameter at the posterior fornix of the vagina, and the amniotic sac and the fetal head were palpable. Therefore, we immediately performed an emergency cesarean section under general anesthesia. We found no blood or effusion in the abdominal cavity, and the retrovesical peritoneum and rectovaginal peritoneum were complete. We opened the uterus and took out a girl with an Apgar score of 9–10 and a weight of 3970 grams. We placed the patient in the lithotomy position and found a transverse fracture with a length of about 4 cm in the posterior fornix of the vagina. We explored the fracture to the uterine cavity and found a vertical crack with a length of 3 cm in the lower segment of the posterior wall of the uterus. We use 1 − 0 absorbable sutures to continuously sew up the crack. One year and seven months after the operation, a color Doppler ultrasound showed a myoma with a diameter of about 3 cm in the cervix. At three years and seven months postoperatively, the cervical fibroid had enlarged to 4 cm. The gynecologist administered a transvaginal cervical myomectomy to the patient. Postoperative pathology revealed a cervical leiomyoma. Conclusions This case report suggests that rupture of the uterine and vaginal fornix may occur even in women who have given birth, necessitating termination of pregnancy by cesarean section when the cervical texture is firm and fails to expand during labor. We need to closely follow up with those patients with uterine rupture.