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.