Omentum prolapses after vaginal delivery following cesarean of a fetal death: A case report

The first and most likely sign of uterine rupture is non-reassuring monitoring of fetal heart rate which can lead to fetal death. In cases of intrauterine fetal death, early diagnosis of uterine rupture based on fetal heart rate monitoring is not possible. The aim of this study is to report a rare case of omentum prolapse from vagina after vaginal delivery following cesarean of a fetal death.
Case Report: A 31 years old woman, G2L1 with gestational age of 38 weeks with labor pain referred to emergency maternity of one of the academic hospitals of Mashhad. Fetal heart was not detected at admission. Spontaneous contraction was appropriate for labor progress. Oxytocin was administered according to decreased contractions. Regarding to head undescending and fetal death and mother's no consent for cesarean, delivery was performed by vacuum. Omentum in vagina was touched before examining the cesarean incision. Patient was transferred to the operating room with a diagnosis of uterine rupture. Laparotomy was performed with fannenstiel incision and rupture was detected at previous cesarean scar with extension to inferior segment that suture was done.
In cases of intrauterine fetal death, since fetal heart rate is not accessible as a risk factor for uterine rupture, it is important to notice labor progress; and in the case of reduced contractions or head undescending especially in active phase of labor, oxytocin administration should be avoided and surgery should be performed.