Uterovaginal Prolapse Complicated by Antepartum Haemorrhage in Shock in Latent Phase of Labour: A Case Report

Abstract

Abstract

Background: The Occurrence of uterovaginal prolapse complicated by antepartum haemorrhage is very rare. Complications include fetal demise, maternal sepsis, and death. This case report presents the rare occurrence of uterovaginal prolapse in a grand multiparous woman who presented in shock and in latent phase of labour, and subsequently had a successful vagina delivery.

Case summary: A 30-year-old unbooked   G6P5+0, 3A woman at 37week 2 days presented with complaint of protrusion and bleeding per vaginum of 3 weeks duration. She was referred as a case of antepartum haemorrhage. At presentation, her pulse rate and blood pressure were 120bpm and 80/50mmhg respectively. The symphysio-fundal height was 33cm with palpable uterine contractions and fetal heart tones were present. Vaginal examination revealed visible cervix and lower uterine segment 4cm below the introitus. The prolapsed cervix was oedematous with multiple ulcers and bleeding edges. The cervix was 2-3cm dilated, 3cm long and soft with the fetus in cephalic presentation at station 0^-1 and the membranes were intact. She was resuscitated, placed in Trendelenburg position, and given parenteral antibiotics, analgesic and buscopan. In 2^nd stage of labour the cervix was well guarded with normal saline soaked abdo-pack to prevent cervical tear and 7 hours after admission to the labour ward, she delivered a live female neonate who weighed 2800g and the estimated blood loss was 300ml. Her postpartum period was uneventful with spontaneous reduction of the prolapse; she was discharged on her third postpartum day and subsequently followed up at the postnatal clinic.

Conclusion: Uterovaginal prolapse complicated with antepartum haemorrhage in shock is very rare. Management of uterovaginal prolapse during labour should be individualized on the basis of fetal condition and the severity of prolapse.. Expectant management is a good option when there is no obstructed labour, as in our case, where the patient delivered vaginally and the prolapse resolved postpartum.