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    Cervical Tear: A Rare Route of Delivery: Case Report: Bhaktii Kohli and Madhu Nagpal

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    Cervical Tear: A Rare Route of Delivery: Case Report: Bhaktii Kohli and Madhu Nagpal

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    Cervical Tear: A Rare Route of Delivery: Case Report: Bhaktii Kohli and Madhu Nagpal

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    International Journal of Clinical Obstetrics and Gynaecology 2020; 4(1): 251-252

    ISSN (P): 2522-6614


    ISSN (E): 2522-6622
    © Gynaecology Journal Cervical Tear: A rare route of delivery: Case report
    www.gynaecologyjournal.com
    2020; 4(1): 251-252
    Received: 04-11-2019 Bhaktii Kohli and Madhu Nagpal
    Accepted: 15-12-2019

    Dr. Bhaktii Kohli


    DOI: https://doi.org/10.33545/gynae.2020.v4.i2d.590
    Senior Resident, ESIC Model
    Hospital, Bharat Nagar, Ludhiana, Abstract
    Punjab, India Cervical laceration is one of the complications of vaginal delivery, but delivery through a cervical os is a
    rarity. Very few cases have been reported so far. Most of the reported cases are not much comparable to
    Dr. Madhu Nagpal ours, where a multiparous woman had a spontaneous vaginal delivery through a posterior cervical tear and
    Professor and Head, Sri Guru Ram an undilated external cervical os, in the absence of any known risk factors.
    Das Institute of Medical Sciences
    and Research, Amritsar, Punjab, Keywords: proximal tibia fracture, MIPPO, knee stiffness, wound dehiscence
    India

    1. Introduction
    Cervical injuries represent a frequent morbidity associated with vaginal delivery. [1]
    Most of the cervical tears are in the lateral aspect of cervix, while some sustain a posterior
    transverse semicircular cervical tear, mimmicking annular cervical detachment [2]
    Cervical tears are responsible for major postpartum haemorrhage. It can be due to the fact that
    they remain unidentified and hence not sutured. Even after repair, hematotrachelos and
    hematometra are some of the complications that may follow. [4]
    Most of the times, spontaneous vaginal delivery through cervical tears has been reported in
    patients with some significant obstetric or medical history or surgical history of cervical
    intervention. We have reported a case of spontaneous vaginal delivery through a cervical tear
    with an undilated external cervical os.

    2. Case Report
    A 30 years old G2P1 (unbooked case), was admitted in the labour room of Sri Guru Ram Dass
    Institute of Medical Sciences and Research, Amritsar, in active phase of labour. It was a
    spontaneous singleton pregnancy which had been uneventful so far. No history of any cervical
    intervention or precipitate labour was identified in the past. On per abdominal examination,
    fundal height corresponded to 36 weeks with regular and good uterine contractions. Fetal heart
    rate was found to be regular with a rate of 136 beats per minute. On digital examination, patient
    was found to be 7-8 cm dilated with absent membranes and vertex at +2 station. The patient was
    shifted to second stage labour room and intravenous line secured with ringer lactate on flow.
    Regular monitoring of fetal heart sound was done. Patient delivered spontaneously after 1 hour
    of the initial examination. Baby cried immediately after birth. Placenta delivered spontaneously
    within 5 minutes of delivery through the posterior cervical tear. (figure 1). After the placental
    separation and delivery, unusual amount of blood loss was noted. On examination, uterus was
    found to be well contracted. Local exploration revealed intact vaginal walls with bleeding angle
    of the posterior cervical tear. (figure2). It was a 4-5 cm annular tear on the posterior lip of
    cervix, extending from 5 o clock to 8 o clock positions while the external os admitted only tip of
    finger. The tear had provided a gateway for the fetus and placenta, causing unusual amount of
    blood loss through the tear after delivery. Hemostasis was achieved after repairing the tear with
    continuous absorbable suture vicryl no 1. The permeability of the external os was examined
    digitally and further indicated by the spontaneous lochial discharge through the os. The patient
    received oxytocin infusion post-partum and 1 gm intravenous ceftriaxone .After an uneventful
    postpartum period, patient was discharged on the third day postpartum.
    Corresponding Author:
    Dr. Bhaktii Kohli 3. Discussion
    Senior Resident, ESIC Model Cervical tear, with an incidence of 1.2% of vaginal deliveries, is one of the undesired
    Hospital, Bharat Nagar, Ludhiana, complications of labour and one of the root cause of postpartum haemorrhage. [5]
    Punjab, India One case of spontaneous vaginal delivery through an unusual posterior cervical tear was reported

    ~ 251 ~
    International Journal of Clinical Obstetrics and Gynaecology http://www.gynaecologyjournal.com

    by Uchida et al in 2006. [6] in the past.


    Another case was reported by Oyelese et al in 2001, in which an Being a spontaneous vaginal delivery, no history of labour
    extensive posterior cervical tear was found after four doses of induction or augmentation was seen in our case.
    misoprostol given for induction. [7] Baby weight >3500grams at birth has been associated with
    Important risk factors are nulliparity, precipitate labour, higher rates cervical tear [10] but in our case, the birth weight of
    operative vaginal delivery and cervical interventions. [8] neonate was 3 kg.
    Induction of labour also increases the probability of cervical Precipitate Labour has also been identified as one of the risk
    damage. [9] factors for cervical tear [11]
    Fibrosis of the cervix, leading to increased resilience and hence This could be a possible explanation of cervical tear in our case
    failure of external os to dialate, is one of the possible as the patient reached the hospital when she was in second stage
    explanation of cervical tears. of labour and hence no labour record was available.
    There are reports of vaginal delivery through these lesions, Regardless of the etiology, this complication could be prevented
    leading to extensive defects in vaginal fornix, bladder or lower by performing a caesarean section on recognition of external os
    uterine segment. rigidity with good and regular uterine contractions and failure of
    In our case, in contrast to the previous studies, no significant cervical dilatation.
    medical history or surgical intervention of the cervix was noted

    Fig 1: Delivery of placenta through cervical tear Fig 2: Suturing of posterior cervical tear

    4. Conclusion lacerations. J Ultrasound Med. 2006 Feb; 25(2):269-71.


    In nulliparous women, cervical effacement precedes cervical 5. Devkota A, Adhikari S, Neupane B. Prostaglandin induced
    dilatation. Hence, strict and careful monitoring of labour should labor a risk factor for cervical tear. N.J Obstet Gynaecol.
    be done. Completion of cervical effacement with good uterine 2006:1:14-18
    contractions and a rigid cervical os is an alarming sign. This 6. Uchil D, Kumakech W, Jolaoso A. Spontaneous vaginal
    may indicate an imminent cervical tear. Hence a caesarean delivery through an unusual posterior cervical tear. J Obstet
    section should be considered immediately to prevent Gynaecol. 2006; 26:263-4
    complications. 7. Oyelese Y, Landy HJ, Collea JV. Cervical laceration
    associated with misoprostol induction. Int J Gynaecol
    5. References Obstet, 2001; 73:161-2.
    1. Landy HJ, Laughon SK, Bailit JL, Kominiarek MA, 8. Melamed N, Ben-Haroush A, Chen R, Kaplan B. Yogev Y.
    Gonzalez-Quintero VH, Ramirez M, et al. Characteristics Intrapartum cervical lacerations: characteristics, risk factors,
    associated with severe perineal and cervical lacerations and effects on subsequent pregnancies. Am. J. Obstet.
    during vaginal delivery. Obstet. Gynecol. 2011; 117:627– Gynecol. 2009; 200:e381–e384.
    635. 9. Parikh R, Brotzman S. Anasti JN. Cervical lacerations:
    2. Pariyar J, Rana A, Gurung Geeta, Pant PRaj. Annular some surprising facts. Am. J. Obstet. Gynecol. 2007;
    detachment of cervix. Gynaecology and obstetric health 196:e17–e18.
    letter 2004; 10:1-2. 10. Harrigan JT, Karbhari D. Halpern A. Term delivery through
    3. Mousa HA, Cording V, Alfirevic Z. Risk factors and a spontaneously occurring cervicovaginal fistula following
    interventions associated with major primary postpartum second-trimester surgical repair. Am. J. Obstet.
    hemorrhage unresponsive to first-line conventional therapy. Gynecol. 1977; 128:912–913.
    Acta Obstet Gynecol Scand. 2008; 87(6):652-61. 11. Hsieh YY, Tsai HD, Chang CC, Yeh LS, Yang TC, Hsu
    4. Sherer DM, Khoury-Collado F, Hellmann M, Abdelmalek TY. Precipitate delivery and postpartum hemorrhage after
    E, Kheyman M, Abulafia O. Transvaginal sonography of term induction with 200 microgrmas misopristol. Zhonghua
    hematotrachelos and hematometra causing acute urinary Yi Xue Za Zhi (Taipei). 2000; 63(1):58-61.
    retention after previous repair of intrapartum cervical

    ~ 252 ~

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