Antenatal diagnosis of vesicouterine fistula

Background: In pregnancy, vesicouterine fistulas usually are diagnosed post partum after cesarean deliveries. Case: An Ill-year-old woman, gravida 3, para 2,with two prior cesarean deli veries had pain and apparent rupture of membranes at 23 weeks' gestation. A t 26 weeks' gestation, she developed increasing suprapubic pain and irregul ar contractions. Ultrasonographic findings included a small uterine defect and possible ballooning of membranes into her bladder. Cytoscopy showed bal looning of amnion into the bladder dome. A viable 900-g female infant was d elivered by classic cesarean, the fistulous tract was excised, and the rupt ure sites were repaired. Conclusion: Vesicouterine fistulas might be diagnosed antenatally. With con tinued contractions and associated uterine rupture, cesarean delivery can b e 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 Obstet ricians and Gynecologists.).