title: Vernix caseosa peritonitis after vaginal delivery.
abstract: BACKGROUND
  Vernix caseosa peritonitis (VCP) is a very unusual complication caused by inflammatory response to amniotic fluid spilled into the maternal peritoneal cavity. Twenty-seven cases have been reported, and all occurred after cesarean section.
  
  
  METHODS
  We present a case of VCP following vaginal delivery; this may be the first case reported after vaginal delivery. Mrs. A, 28 years old, gravida 3, para 2, with one previous cesarean section, was admitted at 41 weeks gestation in active labor. Vacuum extraction was performed to deliver a healthy male baby, 4.410 kg, Apgar scores 7, 8. She developed fever, acute abdominal pain, and distension about 3 hours after delivery. A diagnosis of acute abdomen was made. Laparotomy was performed and it revealed neither uterine scar rupture nor other surgical emergencies, but 500 mL of turbid fluid and some cheesy material on the serosal surface of all viscera. Biopsies were taken. She had a course of antibiotics and her recovery was complete. Histology of the peritoneal fluid and tissue biopsy resulted in a diagnosis of VCP.
  
  
  CONCLUSIONS
  Clinical diagnosis of peritonitis due to vernix caseosa should be considered in patients presenting postpartum with an acute abdomen after vaginal delivery.
authors.affiliation: Department of Obstetrics and Gynecology, Maternity Hospital, Kuwait.
authors.forename: Shameema A
authors.initials: SA
authors.lastname: Sadath
authors.forename: Fathiya I
authors.initials: FI
authors.lastname: Abo Diba
authors.forename: Surendra
authors.initials: S
authors.lastname: Nayak
authors.forename: Iman Al
authors.initials: IA
authors.lastname: Shamali
authors.forename: Michael F
authors.initials: MF
authors.lastname: Diejomaoh
keywords: laparotomy; vaginal delivery; vernix caseosa peritonitis