Antenatal diagnosis of vesicouterine fistula

Background: In pregnancy, vesicouterine fistulas usually are diagnosed postpartum after cesarean deliveries. Case: An Ill-year-old woman, gravida 3, para 2,with two prior cesarean deliveries had pain and apparent rupture of membranes at 23 weeks' gestation. At 26 weeks' gestation, she developed increasing suprapubic pain and irregular contractions. Ultrasonographic findings included a small uterine defect and possible ballooning of membranes into her bladder. Cytoscopy showed ballooning of amnion into the bladder dome. A viable 900-g female infant was delivered by classic cesarean, the fistulous tract was excised, and the rupture sites were repaired. Conclusion: Vesicouterine fistulas might be diagnosed antenatally. With continued contractions and associated uterine rupture, cesarean delivery can be done with excision of the fistulous tract and repair of the rupture sites. (Obstet Gynecol 1999;94:808-9. (C) 1999 by The American College of Obstetricians and Gynecologists.).