Inadvertent primary vaginal incision during cesarean section

A previously undescribed complication of low transverse cesarean section--primary entry into the upper vagina--is reported in two women. The patient at risk is a parturient whose cervix is completely dilated and who has been pushing the second stage labour. Possible complications include bladder injury, vesical fistula, hemorrhage and laceration of adjacent ligamentous structures. Management requires meticulous hemostasis, careful search for bladder injury and anatomical closure of the vaginal defect. The postoperative course and prognosis of well managed cases are good.