Inadvertent primary vaginal incision during cesarean section

Area of Science:

• Obstetrics and Gynecology
• Surgical Complications

Background:

• Low transverse cesarean section is a common obstetric procedure.
• Complications can arise, necessitating careful surgical technique and patient monitoring.

Observation:

• A previously undescribed complication involving primary entry into the upper vagina during cesarean delivery is reported.
• This complication occurred in two women during the second stage of labor after complete cervical dilation.

Findings:

• At-risk patients include those in the second stage of labor with a fully dilated cervix.
• Potential complications include bladder injury, vesical fistula, hemorrhage, and ligamentous lacerations.
• Management involves meticulous hemostasis, thorough bladder injury assessment, and anatomical closure of the vaginal defect.

Implications:

• This finding highlights a new surgical risk associated with cesarean delivery.
• Proper identification and management are essential for favorable postoperative courses and prognoses.
• Enhanced surgical awareness and technique can prevent severe maternal morbidity.