Vesicouterine fistula in pregnancy: a case report.

Background: Vesicouterine fistula is a rare complication of Caesarean delivery. This is the third known report of vesicouterine fistula diagnosed during pregnancy.

Case: Linda (pseudonym), a 28-year-old woman in her second pregnancy, having had a Caesarean delivery in her first pregnancy, was admitted to the delivery unit with possible preterm ruptured membranes at 23 weeks' gestation. She also complained of a fluid-filled sac bulging from her introitus during her admission assessment. Diagnosis of premature rupture of membranes was confirmed by a positive nitrazine paper test and appearance of ferning during microscopic evaluation of vaginal fluid. Cystoscopy, performed 3 days after admission, demonstrated ballooning of amnion into the bladder. At 24 weeks' gestation, the woman had a precipitous vaginal breech delivery. Two months later, the fistula was successfully repaired through a transabdominal route.

Conclusion: Although uncommon in pregnancy, vesicouterine fistula should be considered in women who present with urinary incontinence or recurrent urinary tract infections after a lower transverse Caesarean section. Evaluation in pregnancy is usually limited to cystoscopy. Treatment is usually surgical and is often delayed until 2 to 3 months following delivery.