Navigating vaginal delivery in a patient with severe uterine prolapse: A case report

Pelvic organ prolapse (POP) during pregnancy is rare, with few cases to guide clinical management. Vaginal delivery is possible; however, it is associated with increased risk of antepartum and intrapartum complications. This report discusses a case of intrapartum severe uterine prolapse in pregnancy and management techniques which resulted in a successful vaginal delivery.

A 43-year-old grand multiparous woman (para 9) presented at 40 weeks in labor with stage III uterine prolapse. She had been diagnosed during her antepartum course, but declined a pessary and opted instead for expectant management. Her labor course was complicated by obstructed labor until she underwent manual reduction of her prolapse, subsequent bedrest, and oxytocin augmentation, leading to vaginal delivery of a term neonate. Her third stage was complicated by uterine atony, managed with bimanual massage and uterotonics.

This case illustrates that vaginal delivery is feasible in pregnancies complicated by severe uterine prolapse when pelvic anatomy is appropriately restored. Restoration may facilitate labor progression and reduce the risk of obstructed labor. However, the risk of intrapartum complications remains high. Awareness of these potential complications is critical as impaired uterine contractility from uterine prolapse may limit effective labor mechanics in all stages of labor.