Shahroud University of Medical siences Shahroud Journal of Medical Sciences 2423-6594 12 5 2026 08 29 Case Report: Complete Perineal Body Rupture Following Rectovaginal Fistula in the Second Stage of Vaginal Delivery 13 18 eng Reihane Rajati Department of Midwifery, Islamic Azad University, Mashhad branch, Mashhad, Iran.. reihane.rajati@gmail.com Reyhane Sadat Hosseini Assistant Professor, Fellowship of Pelvic Floor Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran.. mahda.f255@gmail.com Marzieh Faghani Aghoozi Department of Midwifery, Torbat-Jam Faculty of Medical Sciences, Torbat-Jam, Iran.. mahda.f255@gmail.com 2025 09 14 2025 12 16 Background: Obstetric fistula is a severe and disabling reproductive health complication, particularly prevalent in low-resource settings. It involves an abnormal communication between the gastrointestinal or urinary tract and the female genital tract, most commonly resulting from obstructed or prolonged labor. Based on anatomical involvement and etiology, it may manifest as vesicovaginal, rectovaginal, or rectovesicovaginal fistulas. Case Presentation: A 19-year-old primigravida of foreign nationality presented in active labor at 40 weeks gestation. Intermittent hypertensive episodes complicated labor during the second stage. Vaginal delivery resulted in the birth of a healthy female neonate, accompanied by a complete perineal body rupture associated with rectovaginal fistula formation. Conclusion: Even in the absence of significant obstetric, medical, or surgical risk factors at admission, modifiable conditions such as intrapartum hypertension—often linked to nutritional deficiencies—can precipitate severe maternal complications, including obstetric fistulas. This case underscores the importance of vigilant intrapartum monitoring and early intervention in high-risk labor presentations.