Abstract
Primary spontaneous colporrhexis is rare a condition characterised by rupture of the upper one third of the vaginal wall without extension from uterus or cervix in a parous women with an unscarred uterus. In our case the colporrhexis was also a complete one with rupture of the entire vaginal wall layers.A 31-year old, second gravida was booked in our hospital at 36 wks of gestation. She had no comorbities. She had previous full term normal vaginal delivery of an alive baby weighing 2.75kg.At 39 weeks and 4 days gestation she was admitted for induction of labour as she had borderline liquor. Induction was done with 2 doses of misoprostol 25mcg kept vaginally 4 hrs apart. 2 hours after placing the 2ndmisoprost she had spontaneous rupture of membranes with clear liquor draining PV. With strong uterine contractions. She delivered within 45 minutes a live healthy baby of 3kg weight. Placenta was delivered by AMTSL. Bleeding per vagina was within normal limits. During visualization of cervix and vagina prior to closure of episiotomy, omentum was seen coming out of upper part of posterior fornix of vagina. An irregular transverse rent was found and felt behind the cervix. Cervix was intact Uterus had contracted well. There was no excessive bleeding from vagina. Patients vitals were stable. Vagina was immediately packed and patient was shifted to OT after explaining about the unexpected complication and obtaining informed consent from patient and her relatives. Under anaesthesia, Visualisation of cervix and Examination of uterus was done. They were found to be intact. No extension of episiotomy seen. There was a transverse tear of 5 cm involving the posterior fornix. The left edge of the tear was found to be extending slightly upwards for about 2 cm. Omentum was seen protruding through the rent. The edges were dilineated, omentum was pushed inside. The delineated edges of the rent were sutured with 1-0 vicryl with intermittent sutures in two layers. Complete hemostasis was ensured.
Highlights
Colporrhexis is defined as rupture of vaginal vault or upper one third of the vaginal wall
Primary colporrhexis has been described as a vaginal vault tear not
Secondary colporrhexis is a vaginal vault tear which is associated with a rupture that has originated in the uterus or cervix and extended to involve the vagina
Summary
Colporrhexis is defined as rupture of vaginal vault or upper one third of the vaginal wall. Colporrhexis is subdivided into primary or secondary, spontaneous or traumatic, complete or incomplete. Primary colporrhexis has been described as a vaginal vault tear not. Secondary colporrhexis is a vaginal vault tear which is associated with a rupture that has originated in the uterus or cervix and extended to involve the vagina. Incomplete colporrhexis include rupture of vaginal epithelium and the muscularis, whereas complete includes overlying peritoneum as well. Most cases of colporrhexis are of traumatic origin associated with unskilled instrumental delivery, vaginal birth after C-section, myomectomy, precipitate labour and injudious use of oxytocis in labour. The aetiology of the rarer primary spontaneous colporrhexis is unknown and previous vaginal trauma has been implicated. I describe here a case of primary spontaneous complete colporrhexis in a unassumingly healthy multigravida who had an unscarred uterus.
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