A cesarean section is delivery of a viable baby by making an incision into the maternal abdominal and uterine walls. This distinguishes it from delivery of a baby that is ectopic in the peritoneal cavity (advanced abdominal ectopic pregnancy), which is delivered by just making an incision in the maternal abdominal wall. What I am going to describe now is a unique case, quite different from the other two. In this case the baby was delivered by an incision into the maternal abdominal wall and anterior vaginal wall.
It happened in the emergency hours. The woman had been in labor for a long time. The cervix had been fully dilated and effaced for a couple of hours. The baby had been jammed in the maternal pelvis. They took the patient up for a cesarean section for non progress of labor. They followed the standard steps. The divided the peritoneum between the uterus and the bladder and pushed the bladder down. Then they made a transverse incision on the distended 'lower uterine segment' and delivered the baby. But when they started to suture the 'lower segment' incision, they discovered that the incision was not in the lower segment. It was in the anterior vagina. The edge of the vaginal part of the cervix was above the incision.
"It was almost paper thin" said one of them the next day morning during our ward round.
"Stretched out vagina would be that thin" I said. "Have you realized what happened?"
"...." they probably had realized what had happened, but were reluctant to put it in words.
"The fetal head had passed through the cervix and was in the upper vagina. The baby was not delivering because of pelvic contraction below that level. You made an incision in the vagina abdominally and delivered the baby. This must be the first case of this event in the world literature."
"...." they either did not think it was the first case in the world literature, or were not thrilled by that idea.
"You can publish this case in a scientific journal" I said enthusiastically.
"....." they did not seem to think much of the idea.
"This woman has some advantages over other women who undergo a cesarean section" I said. "She will not be at risk of complications like placenta previa, accreta, increta or percreta, and also of rupture of the scar in a future pregnancy."
This should have pleased them, but all I could see there was bewilderment. Perhaps they thought I was being sarcastic.
"What can we call this?" I asked. There was no answer. "We cannot call this abdominal vaginal cesarean section, because a cesarean section requires a uterine incision. We can call this abdominal vaginal delivery."
I moved on with the ward round, not waiting to see their expressions.
It happened in the emergency hours. The woman had been in labor for a long time. The cervix had been fully dilated and effaced for a couple of hours. The baby had been jammed in the maternal pelvis. They took the patient up for a cesarean section for non progress of labor. They followed the standard steps. The divided the peritoneum between the uterus and the bladder and pushed the bladder down. Then they made a transverse incision on the distended 'lower uterine segment' and delivered the baby. But when they started to suture the 'lower segment' incision, they discovered that the incision was not in the lower segment. It was in the anterior vagina. The edge of the vaginal part of the cervix was above the incision.
"It was almost paper thin" said one of them the next day morning during our ward round.
"Stretched out vagina would be that thin" I said. "Have you realized what happened?"
"...." they probably had realized what had happened, but were reluctant to put it in words.
"The fetal head had passed through the cervix and was in the upper vagina. The baby was not delivering because of pelvic contraction below that level. You made an incision in the vagina abdominally and delivered the baby. This must be the first case of this event in the world literature."
"...." they either did not think it was the first case in the world literature, or were not thrilled by that idea.
"You can publish this case in a scientific journal" I said enthusiastically.
"....." they did not seem to think much of the idea.
"This woman has some advantages over other women who undergo a cesarean section" I said. "She will not be at risk of complications like placenta previa, accreta, increta or percreta, and also of rupture of the scar in a future pregnancy."
This should have pleased them, but all I could see there was bewilderment. Perhaps they thought I was being sarcastic.
"What can we call this?" I asked. There was no answer. "We cannot call this abdominal vaginal cesarean section, because a cesarean section requires a uterine incision. We can call this abdominal vaginal delivery."
I moved on with the ward round, not waiting to see their expressions.
