When the path is blocked: A case of a transverse vaginal septum diagnosed in labor

Transverse vaginal septa are rare, with incidence estimated to be between 1 in 30 000 to 1 in 84 000 people. Despite much literature in the gynecologic setting, there is little guidance about how to manage them when diagnosed in labor. A 23-year-old G1P000 patient presented to Labor and Delivery at 40 weeks 0 days with contractions and vaginal bleeding. A sterile bimanual exam found a blind vaginal ending, with no identifiable cervix. A point of care transvaginal ultrasound showed a transverse septum that measured 0.39 cm in thickness, with a normal cervix behind the septum. The patient was offered an exam under anesthesia with possible septum resection or primary cesarean delivery. She elected for an exam under anesthesia, which revealed a small area of dimpling on the septum. This was bluntly dissected along the scar of the previous resection, without hemorrhage or other complications. Subsequently, the cervix was identified, and the exam was 5 cm dilated, 80% effaced. The patient progressed to an uncomplicated vaginal delivery with no hemorrhage noted in the antepartum or postpartum period. Though there is no consensus or official recommendation for how to manage transverse vaginal septa during labor, there is a concern that a transverse vaginal septum during labor can lead to bleeding or obstructed labor, which can potentially result in uterine rupture. Our patient was diagnosed via transvaginal ultrasound, allowing for blunt dissection and ultimately an uncomplicated vaginal delivery; and this option should be considered for such patients identified in the intrapartum period.