title: Unusual complication of vaginal delivery: is misoprostal the cause?
abstract: A 20-year-old primiparous woman who delivered vaginally in a private hospital 5 h ago was referred to our institute as a case of ruptured uterus. She was very pale and tachycardic with well-contracted uterus of 18-week size but had a cervical tear extending up to the left fornix. Examination under anaesthesia showed colporrhexis of posterior vaginal wall with intestines at the site of colporrhexis. Emergency laparotomy confirmed the above findings and also revealed intestinal gangrene involving more than 10 cm. Repair of colporrhexis, cervical tear and resection and anastomosis of small intestines was carried out. She gave a history of administration of five doses of vaginal misoprostal during labour and fundal pressure at the time of delivery. Literature review revealed that vaginal misoprostal can cause overgrowth of clostridial organisms by decreasing the macrophage function and thus can lead to developmental gangrene of reproductive tract and gastrointestinal tract.
authors.affiliation: Department of Obstetrics and Gynaecology, JIPMER, Puducherry, India. dasaripapa@gmail.com
authors.forename: Papa
authors.initials: P
authors.lastname: Dasari
authors.forename: Haritha
authors.initials: H
authors.lastname: Sagili
authors.forename: Gurunandan
authors.initials: G
authors.lastname: Udupi
mesh_terms: D000328:Adult; D002584:Cervix Uteri / Q000293:injuries*; D003013:Clostridium; D036861:Delivery, Obstetric / Q000009:adverse effects*; D005260:Female; D005734:Gangrene; D006801:Humans; D007421:Intestine, Small / Q000382:microbiology / Q000473:pathology; D007743:Labor, Obstetric; D008264:Macrophages / Q000187:drug effects; D016595:Misoprostol / Q000009:adverse effects*; D010120:Oxytocics / Q000009:adverse effects*; D010298:Parity; D036801:Parturition; D011247:Pregnancy; D014597:Uterine Rupture / Q000209:etiology*; D014621:Vagina / Q000293:injuries*; D055815:Young Adult
chemical_list: D010120:Oxytocics; D016595:Misoprostol