Delivery through a Cervical Tear in a Patient with a History of Loop Electrosurgical Excision Procedure and Intact Cervical Os

Abstract

Vaginal delivery through a cervical tear with an intact cervical os is rare. A para one, 35-year-old pregnant woman was admitted for induction of labour at 41 weeks of gestation. She had a history of cervical intraepithelial neoplasia treated with a loop electrosurgical excision procedure 4 years after her first pregnancy. Three doses of vaginal prostaglandin E2 were given for cervical priming. She went into labour 5 hours after the third dose of prostaglandin E2. No syntocinon infusion was administered. After successful delivery of the baby, she had severe vaginal bleeding. Thorough examination in the operating theatre revealed a cervical tear at 3 o’clock, with an intact cervical os of around 5 mm. The cervical tear was repaired. Total blood loss was 700 ml. The patient underwent an uneventful postoperative course and was discharged 4 days later. We conclude that special attention should be paid to women with a history of cervical procedure. If there is evidence of cervical stenosis during spontaneous or induced labour, Caesarean section needs to be considered to prevent complications. Such complications include cervical effacement without corresponding cervical dilatation in the presence of good regular uterine contractions.