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Rupture of the Posterior Cul-De-Sac During Spontaneous Labor

Young, Brett MD; Takoudes, Tamara MD; Lim, Kee-Hak MD; Rana, Sarosh MD

doi: 10.1097/AOG.0b013e3181bd8a61
Case Reports

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.

Rupture of the posterior cul-de-sac during spontaneous labor is a rare event that can cause significant maternal and fetal morbidity.

From the Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

Dr. Rana is supported by National Institutes of Health grant WRHR 5k12HDOO1255.

Corresponding author: Sarosh Rana, MD, 330 Brookline Ave, Kirstein 3182, Boston, MA 02215; e-mail:

Financial Disclosure The authors did not disclose any potential conflicts.

© 2010 The American College of Obstetricians and Gynecologists