BMJ Case Reports 2017; doi:10.1136/bcr-2017-221149
  • Reminder of important clinical lesson

Rupture of the posterior cul-de-sac during trial of labour after caesarean section

  1. Jeroen van Bavel2
  1. 1Education Center, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
  2. 2Gynaecology, Amphia Ziekenhuis Locatie Langendijk, Breda, The Netherlands
  1. Correspondence to Dr Lysanne D C Graafmans, l.d.c.graafmans{at}
  • Accepted 21 November 2017
  • Published 2 December 2017


Rupture of the vaginal wall in unobstructed labour is a rare entity in the developed world. This case report describes rupture of the posterior cul-de-sac in a healthy 34-year-old multiparous woman attempting trial of labour after caesarean section. The woman presented to the labour ward at term with spontaneous onset of contractions. In the second stage of labour, the woman experienced sudden severe abdominal pain, different in character from the contraction pain. Therefore, the baby was delivered by ventouse extraction. As the woman continued to experience severe immobilising abdominal pain during the hospital stay, a CT scan was performed which revealed a haematoma and free fluid at the right side of the uterus. A laparotomy was performed 3 days postdelivery, during which a rupture of the posterior cul-de-sac was found and closed with a continuous suture. The woman was discharged 3 days after laparotomy in good clinical condition.


  • Contributors LDCG is responsible for drafting and revision of the article. MGKD and JvB were responsible for treatmentof the patient. LDV contributed to imaging and investigations. MGKD and JvB revised the manuscript critically for important intellectual content. LDCG, MGKD, LDV and JvB approved the final version of the manuscript to be published.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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