Descend of the womb: a case report and review of literature of pregnancy with uterine prolapse, delivered vaginally using Duhrssen’s incision

Abstract

Pregnancy with prolapse is a rare condition associated with high risk of obstructed labour leading to significant maternal and perinatal comorbidities. Duhrssen’s incision is a simple procedure which can be used for immediate delivery of the fetus when there is an entrapped head and it can reduce the need for caesarean section in such cases, thus decreasing the complications of a major surgery. We report a case of a multigravida in her 30’s with stage 3 pelvic organ prolapse successfully delivered vaginally using the Duhrssen’s incision. In this case, the patient presented in labor room with threatened preterm labor at 33 weeks of gestation. Conservative management was done. However, she went into spontaneous preterm labor at 35 weeks. As per patient's preference and after clinical evaluation the decision for vaginal delivery was taken. At cervical dilatation of 6 cm and 50% effacement, cervix was lying outside the vulva with fetal head entrapped. Duhrssen’s incision was given at 2 o’clock and 10 o’clock position. A vigorous, 2705 grams, male baby was delivered. The incision was sutured using 2-o vicryl. Patient resumed the use of ring pessary at 6 weeks post-partum. It emphasizes on the practicality of a simple procedure which can decrease the need of cesearean section in such a high-risk case where the mother is keen and willing for a vaginal delivery.