Where Did The Baby Enter From? A Case Of "Blind Ending" Vagina

One doesn't need to be a doctor or to have taken a course in Gross Anatomy and Embryology to appreciate the anatomy of the female genital tract, and the role each part of it plays in sexual

intercourse, pregnancy, labour and delivery.
From basic biological sciences we all know about the Vagina, a muscular tube that serves as a receptacle for the penis during sexual intercourse, squeezing/beating it silly until dude capitulates "crying" out a load of semen which contains the male gamete[sex cell], the spermatozoa.
The seed of the "tears" of the "man-handled" penis, the sperm swims it's way through a narrow canal attached to the vagina, called the cervix; and through it gains access to a more spacious passage called the uterus which also serves as the womb,the nidus for the cocnceptus and the growing foetus.
It then exits the Uterus through either of two openings at the upper end of the uterus to gain access to the fallopian tube where it meets with it's bride, the ovum or egg which is the female sex cell released from the Ovaries. There they are UNITED in "holy matrimony" to form the Zygote which then begins it's journey back to the womb.
Amazing. It's a long journey from the vagina to the tubes and back, one that requires patency throughout the length of the genital tract. But in some types of congenital abnormalities of the female genital tract, one of these tubes either fails to develop/form completely or forms partially ,,and this could lead to infertility among other problems.
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 Case Study 
We were in a ward round racking our brains on what treatment plan would be best for a few troublesome cases: a case of Pulmonary Tuberculosis with Pleurisy to rule out Tuberculous Pericarditis in a known HIV patient; and a case of HIV with Typhoid Sepsis with Hepatosplenomegaly.
The Labour ward "Matron"[ a CHEW serving as a midwife actually] sauntered in with confusion written all over her.  We should come, she said; there was a woman in labour who is having good uterine contractions but on vaginal examination she[the CHEW] was lost in the maze of the vagina and couldn't feel the cervix.
"You couldn't feel the cervix?", I retorted; " ordinary common cervix...... Mtchewww"
With that I motioned her to lead the way while I followed like a boss going for an ultimate search.
The woman is a 25 year old primigravida [pregnant for the 1st time] at a gestational age of 40weeks. There were no red flags in the history, she was having strong contractions, each lasting longer than 45s and coming at a frequency of 4 to 5 in 10minutes; fetal decent looked okay[about 1/5 palpable per abdomen] and the fetal heart looked okay. Bottom line, labour was going fine and there was no reason the cervix couldn't be felt.
I gloved up,swabbed the vulva and inserted my hand. Shock! I came out again looked to make sure I wasn't going into the ... I don't know... the whatever. But it was the vagina alright. I went in again: still shock!
The vagina was short, barely 4cm in length, devoid of the normal vaginal folds, so smooth it felt like skin smeared with a lubricant. There was no fornices, hell there was no cervix; it ended blindly in a pouch,dome-like .... a fact that begged the question "where did the sperm pass through for this woman to get pregnant in the first place?".
However on speculum exam there was a pinhole opening at the summit of the dome,so tiny it would barely admit a soldier ant. Good thing though that sperm cells are much more smaller.
She was counselled for an emergency Caesarean section to which she obliged. In the course of the CS a beautiful live male baby that weighed 3kg was delivered. Immediately he took his first breath the operating room erupted in cheers, and he was promptly handed over to the "nurses" for resuscitation.
5minutes...no cry. 6,7,8 ...still no cry! What the hell were they doing to the baby I yelled in my mind. A "nurse" sauntered in from the adjoining room: "baby is not responding, I think he is dead".
That didn't make sense. Was it not the baby we just delivered ?
Here is a woman with a genital tract abnormality who by whatever stroke of luck,either by divine intervention or mere fluke as in chance,was able to get pregnant; and there was no guarantee that she would get pregnant again! And you are just gonna tell her some cock and bull story on this one when she wakes up from Anaesthesia ...????
I removed my gloves and left the lead surgeon to carry on alone. I rushed into the nursery, the "nurses" were already standing arms folded,heads dropped like people bereaved. And the baby had already turned purplish blue. My heart sank.
On auscultation, there was still a heart beat; faint but it was still there. Hope! I started CPR ... Chest compressions with 2 fingers,intermittently blowing in air with the manual suction bulb[there was no Ambubag let alone oxygen]....and vigorous stimulation at intervals.
I carried on for some 5 minutes......and then the room erupted with a cry: joy unspeakable!
When later the reflexes were in tact and the little dude was suckling away vigorously at the mother's breasts ....the picture was perfect.
Oh ...for the Interest of the Ob-Gyns in the house, the uterus was completely normal.
 Morals.
Oh ... None necessarily ... Just JOY.
Maybe there's one after all:
Never say never.
Two actually:
Never give up .... Until there's no longer any heart beat.
 Dedication
To Dr Biesta of NAUTH.
In a similar occasion like this one when all hope was lost, he carried on ....appearing stupid while doing so, until that thrilling cry was heard.
That single incident was what kept me going.

Dr. Chibuike Supercj Chukwudum