Challenges in management and postoperative complications of total uterine procidentia at term: Case report

Abstract

Background

Total procidentia, or complete uterine prolapse, at term pregnancy is an exceptionally rare and severe obstetric condition. This condition, when accompanied by intrauterine fetal demise (IUFD), significantly increases the risks of obstructed labor, maternal morbidity, and poor fetal outcomes. Early recognition and a comprehensive management approach are critical to minimizing adverse outcomes. This case highlights the challenges and importance of multidisciplinary care in managing such a rare and complex presentation.

Case presentation

A 30-year-old gravida 7, para 6 woman at 39 weeks and 5 days of gestation, with no antenatal care, presented with labor symptoms, including a protruding vaginal mass and a two-day history of absent fetal movements. Physical examination confirmed total uterine prolapse and absent fetal heart tones. Ultrasound revealed a third-trimester intrauterine pregnancy complicated by IUFD. Following informed consent, an emergency cesarean section was performed, delivering a 3000 g macerated male stillborn. The surgery also included a bilateral salpingectomy per the patient’s request.

Outcome

The patient’s postoperative course was complicated by partial bowel obstruction on the 2nd postoperative day, managed conservatively. By the 6th postoperative day, she developed wound dehiscence and intra-abdominal infection, necessitating a re-laparotomy and hysterectomy. Multidisciplinary coordination between surgical and anesthesiology teams was essential in managing these severe complications.

Conclusion

This case underscores the critical importance of prompt surgical intervention and rigorous postoperative care in managing total procidentia at term with IUFD. The significant complications encountered highlight the necessity of a multidisciplinary approach and This rare condition also highlight the importance of innovative surgical techniques and rigorous postoperative monitoring to minimize maternal morbidity and improve outcomes in life-threatening obstetric emergencies.