Spontaneous Delivery Through Central Rupture Of The Perineum: A Case Report Saima Ahmad MRCOG

Ruqia Fida FCPS

Objectives

References

1.Barnes J. Central rupture of perineum. J. Obstet. Gynaecol. Br. Empire. 1947;45:351–3572.Tahseen S, McLean G ,Spontaneous delivery through perineum, bypassing the vaginal introitus . J Obstet Gynaecol 2003 Nov 3.Jovanovic D, Jovanovic A. Delivery through central rupture of the perineum. Obstet. Gynaecol. 1972;40:594–5984.Rahimi MA, Haslam AJ. Perineal delivery. N.Z. Med. J. 1990;103:431–4325.Gregory MS, Anwar K, Oates S, Redford D. Perineal delivery in Ehlers Danlos Syndrome. BJOG. 1997;104:505–50

Central rupture of the perineum is the worst, but fortunately, the least frequent of the perineal lacerations. It is considered as an injury that produces a passage from the vagina, opening externally between the anus and fourchette .

We present a case report in which a home delivery of fetus occurred spontaneously, through the central rupture of the perineum, with the intact vaginal and anal orifice.

We report a case in which a 24 years old Mrs. AA Primipara was presented to a hospital with spontaneous delivery of fetus at home confinement. Her height was 5 feet 4 inch and weight was 65 kg. She had a central perineal rupture, without any lesion of the commissure of the vulva, or anal sphincter. The passage of the infant, umbilical cord, and placenta were through the opening thus formed. Patient labour was not prolonged according to the midwife. The weight of the infant was 3.5kg with a normal head circumference and normal height.

One anteriorly in the triangle formed by bulbo cavernosus ,ischiocavernosus and transversus perinei and other posteriorly behind the transversus perinei and in the triangle formed by transversus perenei, levator ani and gluteus maximus

In this case report our conclusion is that the central rupture of the perineum could have been prevented by prompt anticipation and timely intervention by episiotomy.

A written informed consent was obtained from her for publication of this case report and its accompanying images

On examination, her pelvis was adequate and normal (no narrowing of pubic arch ,no contracted pelvis) and there was a posterior wall vaginal tear. The posterior wall vaginal tear was sutured under anesthesia and the central perineal wound was sutured in layers. The patient made uneventful postnatal recovery and was discharged home next day. At her 6 week postnatal visit no cystocele or rectocele, no urinary incontinence or faecal incontinence was observed.

The incidence of central perineal rupture is 1 in 10 thousand births. When the head extends unhindered, it passes over the centre of the perineum. Lessened inclination of the pelvis or deep-set pubic symphysis interferes with this normal method and fetal head lies in rectovaginal space. The pressure and distension on the perineum cause trauma of the posterior wall of the vagina and the pelvic floor whereas perineal skin, posterior commissure and the anus and sphincter remain intact, and the head appears at the centre of the tear through the artificial passage

Review of literature shows that Central rupture of perineum was found most commonly in primigravida under 25 years of age or in cases where previous tear or scar of perineal operation was present. It is most commonly seen in women with long perineum or narrow rigid vulva with narrow pubic arch or contracted pelvis, cephalic presentation and strong powerful uterine contractions or precipitate labour.

Kovacs (1942) proposed theory of congenital hernia caused by weakness of pelvic fascia and muscles at 2 sites .i.e.

Case Report

Discussion

Consent

Conclusion