CASE REPORT: PDF OnlySimultaneous Uterine and Urinary Bladder Rupture in an Otherwise Successful Vaginal Birth After Cesarean DeliveryHo, Szu-Yinga; Chang, Shuenn-Dhyb, c; Liang, Ching-Chungb, c, * Author Information aDepartment of Obstetrics and Gynecology, Hsinchu Cathay General Hospital, Hsinchu, Taiwan, R.O.C. bDepartment of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan, R.O.C. cChang Gung University College of Medicine, Taoyuan, Taiwan, R.O.C. *Correspondence to: Dr Ching-Chung Liang, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, 5, Fu-Shin Street, Kweishan, Taoyuan 333, Taiwan, R.O.C. E-mail: [email protected] Received: May 17, 2010; • Accepted: June 28, 2010. Journal of the Chinese Medical Association 73(12):p 655-659, December 2010. | DOI: 10.1016/S1726-4901(10)70143-X Metrics Abstract Uterine rupture is the primary concern when a patient chooses a trial of labor after a cesarean section. Bladder rupture accompanied by uterine rupture should be taken into consideration if gross hematuria occurs. We report the case of a patient with uterine rupture during a trial of labor after cesarean delivery. She had a normal course of labor and no classic signs of uterine rupture. However, gross hematuria was noted after repair of the episiotomy. The patient began to complain of progressive abdominal pain, gross hematuria and oliguria. Cystoscopy revealed a direct communication between the bladder and the uterus. When opening the bladder peritoneum, rupture sites over the anterior uterus and posterior wall of the bladder were noted. Following primary repair of both wounds, a Foley catheter was left in place for 12 days. The patient had achieved a full recovery by the 2-year follow-up examination. Bladder injury and uterine rupture can occur at any time during labor. Gross hematuria immediately after delivery is the most common presentation. Cystoscopy is a good tool to identify the severity of bladder injury. © 2010 by Lippincott Williams & Wilkins, Inc.