Combined bladder, urethral and uterine rupture after a normal, spontaneous vaginal delivery at home: a case report.
BACKGROUND
Uterine rupture and associated injury to the maternal bladder and urethra have been rarely reported. All those cases were associated with a scarred uterus or augmentation of labor. We report a case of simultaneous bladder, urethral and uterine rupture in an unscarred uterus following delivery at home.


METHODS
A 22-year-old woman was referred from a peripheral hospital to the emergency unit of the Medical Faculty, Yüzüncü Yil University, after delivering at home. On vaginal examination, the bladder neck and proximal one third of the urethra were ruptured. Intraoperatively it appeared that the posterior wall of the bladder and bladder base had ruptured and separated from the level of the interureteric ridge. An extensive rupture of the lower uterine segment to the left sidewall of the uterus was seen.


CONCLUSIONS
To prevent these complications, uneducated, traditional birth attendants should be replaced by at least midwives, and the rate of unsupervised home delivery should be reduced.
Zeteroğlu
Sahin
S
Department of Obstetrics and Gynecology, Faculty of Medicine, Yüzüncü Yil University, Van, Turkey. szeteroglu@hotmail.com
Bayrakli
Hasmet
H
Yilmaz
Yuksel
Y
Sahin
H Guler
HG
D000328:Adult; D005260:Female; D006700:Home Childbirth / Q000009:adverse effects*; D006801:Humans; D011247:Pregnancy; D012422:Rupture, Spontaneous; D014219:Trial of Labor; D014521:Urethra / Q000293:injuries* / Q000601:surgery; D001743:Urinary Bladder / Q000293:injuries* / Q000601:surgery; D014597:Uterine Rupture / Q000209:etiology* / Q000601:surgery; D014599:Uterus / Q000293:injuries / Q000601:surgery