BACKGROUND: Women with genital anomalies are at increased risk of labor dysfunction. Rupture of the posterior cul-de-sac causing an intraabdominal delivery is a rare complication of labor that may be related to a congenitally atretic vagina.
CASE: A nulliparous woman at 28 weeks of gestation with a known short vagina presented with preterm labor; her cervix could not be palpated or visualized. At cesarean delivery, the cervix was intraabdominal and the fetal head was delivered in the abdomen. A large rent in the posterior cul-de-sac required repair to restore correct anatomical positioning. The uterus was intact.
CONCLUSION: Rupture of the posterior cul-de-sac is a rare event that can cause significant maternal and fetal morbidity.