# Circumferential Vaginal Tear During the Cesarean Section: A Complication of Vaginal Hand Assistance in a Deeply Impacted Fetal Head

## TL;DR

A woman had a rare vaginal tear during a cesarean section due to a deeply impacted fetal head, requiring emergency surgery and multidisciplinary care.

## Contribution

Highlights a rare complication of vaginal hand assistance during cesarean delivery of a deeply impacted fetal head.

## Key findings

- A full-thickness circumferential vaginal tear occurred during cesarean section due to vaginal hand assistance.
- Multidisciplinary involvement was necessary for surgical repair and management of postoperative complications.
- The case underscores the need for prompt diagnosis and management in obstetric emergencies.

## Abstract

We present the case of a 29-year-old, G2P1+0 pregnant woman who was unbooked and presented to the emergency room at 36+5 weeks gestation with complaints of leaking liquor, labour pains, vaginal bleeding and raised blood pressure. Her history revealed previous vaginal delivery and index pregnancy complicated with obstetric cholestasis, pre-eclampsia, and fetal growth restriction. During her hospital course, the patient underwent an emergency cesarean section due to uncontrolled blood pressure and pathological cardiotocograph (CTG) revealing a deeply impacted fetal head intraoperatively and necessitating an inverted T incision on the uterus. Although the newborn was delivered successfully, a full-thickness circumferential tear in the vaginal vault was discovered, requiring immediate surgical repair with the involvement of a urologist. The patient experienced postoperative complications related to pre-eclampsia and sepsis but was eventually discharged in stable condition. This case highlights the importance of prompt diagnosis and management of obstetric emergencies especially in the case of deeply impacted fetal head, and the need for a multidisciplinary approach to address complications such as vaginal tears during cesarean sections due to vaginal assistance in delivering the baby.