Obstetric Trauma Following Empiric External Cephalic Version by a Traditional Birth Attendant in a Grand Multipara: Intraoperative Discovery of Fetus and Placenta in the Abdominal Cavity

Abstract

Cesarean delivery has become one of the most frequent interventions in obstetrics, and abnormal fetal presentation continues to be a major indication. External cephalic version (ECV) is commonly used to reduce the need for cesarean delivery, but when performed in uncontrolled settings, it may lead to serious complications. We report the case of a 39-year-old grand multipara (G11P11) referred from a rural community after undergoing an emperic ECV attempted by a traditional birth attendant eight days before admission. She developed premature rupture of membranes with persistent leakage for one week, followed by severe abdominal pain, intrauterine fetal demise at 34 weeks, sepsis, and severe anemia. Ultrasound revealed oligohydramnios and fetal death. An urgent exploratory laparotomy was performed with antibiotic coverage and transfusion. Intraoperatively, a complete uterine rupture with retroperitoneal extension was identified, with the intact amniotic sac containing the fetus free in the left iliac fossa and the placenta completely separated within the abdominal cavity. Emergency hysterectomy with left oophorectomy, serosal bowel repair, bilateral uterine artery ligation, and extensive abdominal lavage was undertaken. The patient recovered favorably with intensive postoperative care and was discharged on day eight. This case emphasizes that uterine rupture can occur even in women without previous uterine surgery, particularly in the context of extreme multiparity and non-medical obstetric practices. It highlights the importance of performing ECV exclusively in hospital settings, ensuring timely referral, and strengthening community education to prevent catastrophic maternal outcomes.