Extensive cervico-vaginal ischemic injury reaching the bladder base following obstructed labor in a macrosomic pregnancy: a case report.

INTRODUCTION

Fetal macrosomia, defined as a birth weight (BW) ≥4000 g, is associated with increased maternal and neonatal morbidity, particularly when BW exceeds 4500 g. While complications such as shoulder dystocia and postpartum hemorrhage are well recognized, extensive ischemic soft-tissue injury of the lower genital tract and adjacent urinary structures due to obstructed labor alone is exceedingly rare.

CASE PRESENTATION: A 22-year-old gravida 3, para 2 woman at 40 weeks of gestation presented in active labor with signs of cephalopelvic disproportion, a prominent caput succedaneum, and profuse genital bleeding. Examination revealed severe ischemic-hemorrhagic injury and devitalization of the cervix and the anterior and posterior vaginal walls, extending to the level of the bladder base. Ultrasound confirmed fetal macrosomia and persistent occiput posterior position. An emergency cesarean section was performed, followed by a peripartum hysterectomy and partial vaginal wall resection due to extensive lower genital tract injury. The neonate was delivered in good condition with Apgar scores of 10 at both 1 and 5 min. Both mother and infant were discharged in stable condition the next day.

DISCUSSION: This case represents a rare instance of severe ischemic soft-tissue injury of the lower genital tract, consistent with necrosis, caused by prolonged obstructed labor in the setting of macrosomia, without prior surgical intervention. Sustained mechanical pressure during labor can compromise perfusion to pelvic tissues, resulting in life-threatening complications if not promptly addressed.

CONCLUSION

Early recognition of obstructed labor and rapid surgical intervention are critical to prevent severe maternal morbidity in macrosomic pregnancies. This case highlights the importance of timely decision making in labor management to avoid irreversible complications.