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Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 34-35

Laparoelytrotomy: An inadvertent complication of cesarean section in advanced labor


Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission31-Jan-2018
Date of Acceptance17-May-2018
Date of Web Publication29-Jun-2018

Correspondence Address:
Anish Keepanasseril
Department of Obstetrics and Gynecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantri Nagar, Pondicherry - 605 006
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJAMR.IJAMR_7_18

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  Abstract 


Laparoelytrotomy refers to the inadvertent delivery of the fetus through transverse incision over the vagina during a cesarean section. It is found to be associated with increased risk of maternal morbidity. Being an unintended, complication of cesarean section in advanced labor; it can be avoided by proper planning of the uterine incision. We report a case of inadvertent laparoelytrotomy during cesarean section for cephalopelvic disproportion in the second stage.

Keywords: Advanced labor, cesarean section, laparoelytrotomy


How to cite this article:
Kothandaraman K, Midhuna P V, Maurya DK, Keepanasseril A. Laparoelytrotomy: An inadvertent complication of cesarean section in advanced labor. Int J Adv Med Health Res 2018;5:34-5

How to cite this URL:
Kothandaraman K, Midhuna P V, Maurya DK, Keepanasseril A. Laparoelytrotomy: An inadvertent complication of cesarean section in advanced labor. Int J Adv Med Health Res [serial online] 2018 [cited 2018 Dec 15];5:34-5. Available from: http://www.ijamhrjournal.org/text.asp?2018/5/1/34/235613




  Introduction Top


Laparoelytrotomy refers to delivery of baby through a vaginal incision during cesarean section, which was introduced in the nineteenth century to reduce mortality rates from sepsis.[1] In the current era, where most cesarean section are performed through a Kerr's incision, and laparoelytrotomy almost always occurs accidentally.[1],[2],[3],[4] We report a case of inadvertent laparoelytrotomy during cesarean section for cephalopelvic disproportion in second stage


  Case Report Top


A 27-year-old second gravida with a previous vaginal delivery was admitted to labor ward in the second stage. On examination, Bandl's ring was noted with one-fifth of fetal head still palpable abdominally. Vaginal examination revealed fully dilated cervix, vertex at − 1 station with Grade III molding and 2+ caput. Emergency cesarean section was performed in view of obstructed labor. Intraoperatively, the formation of Bandl's ring was noted. Bladder was drawn up with lower segment stretched and thinned out. A female baby weighing 3400 g with Apgar score of 8 at 5 min was delivered.

At the time of attempted uterine closure, incision was found to be over vagina, about 1.5 cm below anterior lip of cervix, instead of being in lower uterine segment. Anterior vaginal fornix was recreated by suturing-free vaginal flap approximately 1 cm proximal to anterior cervical lip. She had atonic uterus which needed the application of B-lynch sutures, in addition to oxytocics. She received one unit blood transfusion in view of postpartum hemorrhage (traumatic and atonic; Assessed Blood loss-1800 ml). Her posttransfusion hemoglobin was 8.2 g/dl. Her postoperative period was uneventful and was discharged on the 10th postoperative day on hematinics.


  Discussion Top


Transverse vaginal incision or laparo-elytrotomy is an inadvertent and rare complication which occurs during cesarean sections performed in advanced labor.[1] In advanced labor, lower uterine segment is stretched out and considerable vaginal advancement occurs. It may lead to maternal morbidity such as traumatic postpartum hemorrhage, injury to the bladder/ureters and difficulty in reconstructing the vagina.[1],[2],[3],[4],[5],[6] Once inadvertent vaginal entry occurs, prompt recognition and repair are of utmost importance. Distal vaginal flap should be sutured 1 cm proximal to the anterior cervical lip, recreating the fornix.

As the number of second stage cesarean section are increasing, awareness of such a complication and planning uterine incision 2 cm from the uterine attachment of vesicouterine fold of peritoneum can avert this risk, as it can happen even in experienced hands [3] [Figure 1]. Early recognition and meticulous anatomic correction of the vaginal defect can avert the morbidity associated with such cases.
Figure 1: The sites for Kerr's incision in lower segment cesarean section (A) and the accidental incision in laparoelytrotomy (B)

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Pereira N, Rasner JN, Brannon RK, Green MA. Inadvertent vaginal entry during cesarean delivery: A report of two cases. J Reprod Med 2014;59:429-32.  Back to cited text no. 1
[PUBMED]    
2.
Peleg D, Perlitz Y, Pansky S, Levit A, Ben-Ami M. Accidental delivery through a vaginal incision (laparoelytrotomy) during caesarean section in the second stage of labour. BJOG 2001;108:659-60.  Back to cited text no. 2
[PUBMED]    
3.
Rashid M, Rashid M. Accidental delivery of a baby during a caesarean section through a vaginal incision (a laparoelytrotomy). BMJ Case Rep 2010;2010. pii: bcr0720103135.  Back to cited text no. 3
    
4.
Goodlin RC, Scott JC Jr., Woods RE, Anderson JC. Laparoelytrotomy or abdominal delivery without uterine incision. Am J Obstet Gynecol 1982;144:990-1.  Back to cited text no. 4
    
5.
Gortzak-Uzan L, Walfisch A, Gortzak Y, Katz M, Mazor M, Hallak M, et al. Accidental vaginal incision during cesarean section. A report of four cases. J Reprod Med 2001;46:1017-20.  Back to cited text no. 5
    
6.
Işik AZ, Gülmezoğlu M. Laparoelytrotomy: Abdominal delivery without uterine incision. Am J Obstet Gynecol 1991;165:781.  Back to cited text no. 6
    


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