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Transmural vaginal-to-bladder injury from an obstructed labor pattern
Arielle M Allen1, Tracy Lakin, S Abbas Shobeiri
1From the Division of Urogynecology, Department of Obstetrics and Gynecology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; and The Womens Health Group, St John Medical Center, Tulsa, Oklahoma.
Obstetrics and Gynecology
|January 22, 2011
Summary
Prolonged obstructed labor can cause severe obstetric trauma, including vesicovaginal fistulas. This case highlights transmural vaginal-to-bladder damage from prolonged labor, a rare complication in developed nations.
Area of Science:
- Obstetrics and Gynecology
- Trauma Surgery
Background:
- Vesicovaginal fistulas are severe complications of obstetric trauma, particularly prolonged obstructed labor.
- These injuries, often resulting from ischemic damage between the fetal head and maternal tissues, are infrequent in developed countries.
Observation:
- A patient presented with signs of obstructed labor, including a crowning fetal head and no fetal heart tones.
- Postpartum, the patient developed irritative voiding symptoms, vaginal stenosis, and cystoscopic findings indicated bladder base injury.
Findings:
- The case demonstrates significant transmural damage extending from the vagina to the bladder.
- Evidence suggests a direct link between the prolonged obstructed labor and the observed vesicovaginal injury.
Implications:
- This case underscores the potential for severe, direct tissue damage during obstructed labor.
- Recognizing and managing such obstetric trauma is crucial for patient outcomes.
- Further research may elucidate the mechanisms and long-term effects of transmural injuries in obstetric settings.
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