Pedunculated annular tear of the uterine cervix during vaginal delivery: the bases for good obstetric practice in Cameroon

Abstract

Cervical tears are fairly scarce complications in vaginal deliveries. The intricacies of the annular variant are not yet mastered and its management is still not codified today. We report the case of a 38-year-old parturient, pauci gesture, with a history of a caesarean
section and a spontaneous miscarriage, at 40 weeks of gravid amenorrhea. The patient arrived in the latency phase of labour in a context of trial of scar. 6 hours into admission, she felt an urge to push with cervical dilatation of 6 cm; upon physical examination, a
semi-annular posterior cervical tear extending from 3 to 9 hours was noted, with ischemic and edematous cervical tissue visible at the introitus anterior to the foetal head. Following vaginal delivery through the newly created orifice, the tear extended, leaving just a two centimetre cervical flap pedicled to the cervix at 12 hours, with no active bleeding. After ruling out uterine rupture, the tear was repaired. Postpartum care was straightforward. Although the management and impact of this type of tear on the obstetric prognosis of the patient are still insufficiently documented, we recommend cervicoisthmic cerclage and elective caesarean section in order to avoid any premature incident from the age of viability.