Vaginal Birth at 8 cm Because of Severe Cervical Oedema: A Case Report

Cervical oedema during labour is relatively common, but severe circumferential oedema persisting at advanced dilation is rare, particularly in multiparous women. In such cases, the swollen cervix may mimic an obstructive mass and raise concern for labour obstruction, cervical laceration or avulsion if pushing is initiated.

We report the case of a 41-year-old Gravida 5, Para 4 woman who underwent induction of labour at 39 weeks' gestation for diet-controlled gestational diabetes. Labour progressed to 8 cm dilation, at which point a tense, circumferential, purple-hued cervical swelling developed. The clinical presentation raised concern for obstructed labour and potential cervical trauma, although maternal and fetal parameters remained reassuring. The main diagnostic challenge was to distinguish severe reactive cervical oedema from cervical prolapse, haematoma or other cervical pathology. After interdisciplinary discussion and detailed counselling, the patient chose to proceed with a cautious trial of pushing. This decision was based on multiparity, a deeply engaged fetal head, reassuring fetal status, the absence of clinical obstruction to descent and the immediate availability of senior obstetric support and emergency resources. She achieved spontaneous vaginal delivery of a healthy infant within two pushes, without instrumentation, cervical trauma, postpartum haemorrhage or neonatal complication. The cervix remained oedematous but intact. Partial resolution was observed by postpartum Day 3, and follow-up colposcopy at 2 months showed no suspicious cervical lesion. Written informed consent for publication was obtained from the patient.

This case illustrates that, in carefully selected multiparous women, severe reactive cervical oedema at advanced dilation may not necessarily preclude vaginal birth. However, this observation is hypothesis generating and should not be generalised to nulliparous women, cases with high fetal station, suspected obstruction, fetal compromise or limited access to emergency obstetric care.