Urethral avulsion injury during vacuum extraction delivery

Abstract

Vacuum extraction is one of the common methods used for assisted vaginal delivery. The common maternal complications of the devise are cervical vaginal and perineal lacerations. Isolated avulsion injury of the vagina and urethra is unusual. A 24-year-old primigravida underwent induction of labor with oxytocin for postdated pregnancy at a district level hospital. Vacuum extractor with metallic cup was used to assist the second stage of labor. However the method was unsuccessful and on release of the cup there was pervaginal and periurethral bleeding. She underwent cesarean section and a normal baby was delivered. Subsequently she was referred to our hospital on the first postoperative day for further management. General examination revealed pallor tachycardia and low blood pressure. Local examination revealed avulsion of distal posterior urethral wall with the distal anterior vaginal wall. She was resuscitated with intravenous fluids and blood transfusion. She received antibiotics and underwent suprapubic cystostomy. (excerpt)