In some reports, the authors suggest management by total abdominal hysterectomy with bilateral salpingo-oophorectomy; however, subtotal or supravaginal
hysterectomy, drainage alone, and surgical closure of the perforated uterine wall have been reported in different cases (6, 11).
On 17 December 2015 a joint team of urologists and obstetrician-gynecologists performed the following surgical treatment: laparotomy, vesicouterine fistula excision, removal of the fetus from the bladder cavity, bladder defect closure, and supravaginal
amputation of uterus with removal of both fallopian tubes.
The cervix is lowermost part of the uterus, cylindrical in shape and measures about 2.5 cm length and diameter is divided into a supravaginal
part--the part lying above the vagina and a vaginal part which lies within the vagina, each measuring 1.25 cm.
Although a supravaginal
hysterectomy just after the cesarean section (the first surgery) was done at 37 weeks of gestation, a 16-cm placental mass close to the internal os of the uterus could not be removed.
Transvaginal sonography (TVS), on the other hand, is objective, less invasive, and allows for visualization of the supravaginal
cervix as well as the vagina, which is impossible to accomplish digitally if the cervix is closed, she noted.
It may arise either from supravaginal
part of cervix or vaginal part of cervix.
The pericervical ring is located in the supravaginal
portion of the cervix, It's a ring of endopelvic fascia that has to be put back to each ipsilateral uterosacral ligament at the level of each ischial spine.