Preterm vaginal en caul delivery in a case of severe oligohydramnios with pyelonephritis


  • Kashmira Ghosh Department of Obstetrics and Gynecology, Silchar Medical College, Silchar, Assam, India
  • Arun Paul Choudhury Department of Obstetrics and Gynecology, Silchar Medical College, Silchar, Assam, India



En caul, Preterm, Oligohydramnios, Pyelonephritis


En caul deliveries are very rare and are associated with prematurity. Approximately 40 percent of spontaneous premature births are thought to be caused by infection.  Preterm along with oligohydramnios can lead to en caul delivery. We report a case of 27-year-old gravida 4 multiparous women with a history of 2 normal vaginal deliveries NSVD and 1 spontaneous abortion, who presented at 32 weeks of gestation in active labour and delivered preterm viable female with an intact placenta contained within the amniotic sac as a unit “en caul.” Since the patient gave a history of lower back pain with burning micturition for 1 month which remained consistent after delivery, ultrasonography whole abdomen was done and bilateral pyelonephritis was diagnosed. However, the baby’s sepsis screen was negative and discharged healthy.  We report this case because of its rarity of occurrence and to show that intact amniotic membrane during birth can protect the baby from birth trauma and infections.


Lin CH, Lin SY, Yang YH, Shih JC, Shih JC, Lee CN et al. Extremely Preterm Cesarean Delivery “En Caul. Taiwanese J Obstet Gynecol. 2010;49(3):254-9.

Greenstein J, Panzo W, O’Connor J, Hahn B. En Caul delivery. J Emergency Med. 2016;50(2):333-4.

Abouzeid H, Tornton JG. Pre-term delivery by Caesarean section ’en caul’: A case series. Eur J Obst Gynecol Reprod Biol. 1999;84(1)51-3.

Jin, ZX, Wang Q, Xu P, Wang, Ai W. Cesarean section en caul and asphyxia in preterm infants. Acta Obstetricia et Gynecologica Scandinavica. 2013;92(3):338-41.

Richmond JR, Morin L, Benjamin A. Extremely Preterm Vaginal Breech Delivery en Caul. Obste Gynecol. 2002;99(6):1025-0.

Stoelinga B, Bienstock J, Goodwin C, Hueppchen N. En caul delivery of extremely preterm infants: Does it make a difference? Am J Obste Gynecol. 2006;195(6):S75.

Lettieri L, Vintzileos AM, Rodis JF, Albini SM, Salafia CM. Does idiopathic preterm labor resulting in preterm birth exist? Am J Obstet Gynecol. 1993;168:1480-5.

Minkoff H. Prematurity: infection as an etiologic factor. Obstet Gynecol. 1983;62:137-44.

Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM, Spong CY, Preterm birth. In:Williams obstetrics. 25th ed. New York. McGraw-Hill Edu. 2018:811-2.

Malik R, Sarfraz A, Faroqui R, Onyebeke W, Wanerman J. Extremely Preterm (23 Weeks) Vaginal Cephalic Delivery En Caul and Subsequent Postpartum Intraventricular Hemorrhage and Respiratory Distress: A Teaching Case. Hindawi Case Reports Obst Gynecol. 2018,2018:3.

Kelly T. The pathophysiology of premature rupture of the membranes. Curr Opin Obstet Gynecol. 1995;7:140-5.

Polzin WJ, Brady K. The etiology of premature rupture of the membranes. Clin Obstet Gynecol. 1998;41:810-6.

Taylor KH, Schnabel RD, Taylor JF. Impaired collagen chaperone results in preterm PROM. Proc Natl Acad Sci USA. 2006;103:13267-8.

Heggarty H, Shenouda D, Grisdale M. Born in a caul. Remarkable survival. Am J Dis Child. 1975;129:955.

Prabakar C, Nimaroff ML. Perfectly packaged: Upon delivery, the infant was still enclosed in the amniotic sac. Am J Obste Gynecol. 2012;207(1):80-1.

Thibeault DW, Eugene C, Beatty Jr, Robert T, Hall MT, Sandra K et al. Neonatal pulmonary hypoplasia with premature rupture of fetal membranes and oligohydramnios. J Pediat. 1985;107:2:273-7.






Case Reports