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Abstract
Changing demographics of the obstetric population with older mothers, raised BMI, increased CS rates, along with the challenge of keeping training within the EWTD constraints makes it important to revisit bladder injuries at CS. We present 2 different presentations of bladder injuries-one at CS and the other later in the postoperative period.
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G1P0 with a history of coeliac disease and previous ectopic pregnancy had a twin pregnancy complicated by APH, gestational diabetes, spontaneous rupture of membranes and required emergency c/s for suspected fetal compromise. At c/s the bladder was noted to be high. Delivery was uneventful but following bleeding from the bladder peritoneum, a 5cm incision was seen in the dome of the bladder. This was repaired, SPC used and a normal cystogram 2 weeks post op.
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G2P1 with a previous CS presented at term in spontaneous labour. Following fetal bradycardia at full dilatation and OP with a high head, an emergency CS was carried out. At c/s bladder was noted to be adherent and was reflected down. Delivery was uneventful but a uterine angle extension and bloodstained urine was noted in catheter. Postop day 1 following clinical assessment of urine pooling in the vagina, an urgent CT urogram showed a 1.2 cm defect in the posterolateral bladder wall in direct communication with the CS incision. A laparotomy with re-suturing of the uterine incision, cystoscopy, retrograde ureterograms, insertion of ureteric stents, repair of bladder injury, insertion of urethral and supra pubic catheters was performed with urologist in attendance. Following a check cystoscopy, the catheters were removed and recovery was uneventful.
Utero-vesical fistula
Normal cystogram
Early identification and repair of bladder injuries at c/s is essential to reduce morbidity. Risk factors, presentations and management are summarised in the poster.