ANTERIOR VAGINOTOMY - ABDOMINAL DELIVERY WITHOUT A UTERINE INCISION

To determine whether planned anterior vaginotomy is a logical and safe means of avoiding a uterine scar with term abdominal delivery. I reco rded the complications of the technique and whether vaginal birth afte r anterior vaginotomy occurred. Thirteen anterior vaginotomies were do ne when the vagina had advanced during prolonged second stage. The pro cedure appears safe, although one patient had a postpartum bladder fla p hematoma and one had gross hematuria postpartum Three had postpartum endometritis and one was given a blood transfusion. In the six with r ecords of follow-up pregnancies, two had elective cesareans, four atte mpted vaginal birth after vaginotomy with two failures (delivered by c esarean). The two successful procedures were uncomplicated. I conclude that unintended anterior vaginotomy should be coded. Such coding and analysis are required before it can be recommended that anterior vagin otomy replace cesarean after considerable vaginal advancement occurs. Vaginal advancement (and cervical retraction) during the second stage of labor requires further study.