Anterior cervico-vaginal tear along with posterior bladder wall rupture: a rare case report

A 25 year old female presented to our emergency as a case of G3P2+0 (2A and H), full term pregnancy with intrauterine foetal demise with obstructed labour with severe anaemia. In view of obstructed labour with severe anaemia suspicion of rupture uterus was raised. Abnormal contour of abdomen also raised suspicion of bladder tumour. Here emergency caesarean section was done, peroperatively she was diagnosed as a case of anterior cervicovaginal rupture along with posterior bladder wall rupture which is a rare entity. Uterine closure was done along with anterior cervico-vaginal wall with posterior bladder wall repair. This repair was done through transbladder route. Unique finding of this case was tear of anterior cervico-vaginal region with associated posterior bladder wall tear without rupture of uterus despite of obstructed labour in multiparous women. Most probable cause behind this type of injury is impacted head in neglected or obstructed labour responsible for ischemia and necrosis.