Laparoelytrotomy: An inadvertent complication of cesarean section in advanced labor

Keerthana Kothandaraman; PV Midhuna; Dilip Kumar Maurya; Anish Keepanasseril

doi:10.4103/IJAMR.IJAMR_7_18

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

Laparoelytrotomy: An inadvertent complication of cesarean section in advanced labor

Keerthana Kothandaraman, PV Midhuna, Dilip Kumar Maurya, Anish Keepanasseril
Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India

Date of Submission	31-Jan-2018
Date of Acceptance	17-May-2018
Date of Web Publication	29-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

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/IJAMR.IJAMR_7_18

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 2023 Mar 29];5:34-5. Available from: https://www.ijamhrjournal.org/text.asp?2018/5/1/34/235613

Introduction

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

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 10^th postoperative day on hematinics.

Discussion

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

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6.	Işik AZ, Gülmezoğlu M. Laparoelytrotomy: Abdominal delivery without uterine incision. Am J Obstet Gynecol 1991;165:781.