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Vesicouterine fistula after vacuum delivery and two previous cesarean sections. A case report
1Departments of Obstetrics and Gynecology, University of Pennsylvania Medical Center and Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
Background:
Vesicouterine fistulas are associated with cesarean section and more rarely with vaginal birth after cesarean (VBAC). Many surgical approaches exist, including hysterectomy.
Case:
A vesicouterine fistula was diagnosed after VBAC in a 34-year-old multipara with two previous cesarean sections. The defect failed to close after four months of bladder drainage. Closure via laparotomy with an omental flap and preservation of the uterus was successful.
Conclusion:
Vesicouterine fistula can occur after VBAC, and failure of conservative therapy can be treated abdominally with preservation of the uterus.