title: Spontaneous intrapartum vesicouterine fistula.
abstract: BACKGROUND
  Vesicouterine fistulae as an obstetrical complication have been reported only in women with a history of cesarean. We present a patient with no such history who developed a vesicouterine fistula after vaginal delivery.
  
  
  METHODS
  A 43-year-old gravida 5 at term with no history of cesarean presented in the latent phase of labor. Gross hematuria was noted intrapartum, and a foley catheter was placed. A cystogram showed an extraperitoneal bladder perforation. The patient had urinary incontinence despite Foley catheter drainage. The diagnosis of vesicouterine fistula was made by cystoscopy and fistulogram. The patient had a successful repair at 3 months.
  
  
  CONCLUSIONS
  This is a rare case of a vesicouterine fistula developing during a pregnancy with no previous cesarean. Accurate diagnosis is essential because surgical repair has an excellent outcome.
authors.affiliation: Department of Obstetrics, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio, USA. bilalkaa@hotmail.com
authors.forename: Bilal
authors.initials: B
authors.lastname: Kaaki
authors.forename: Michael
authors.initials: M
authors.lastname: Gyves
authors.forename: Howard
authors.initials: H
authors.lastname: Goldman
mesh_terms: D000328:Adult; D005260:Female; D005402:Fistula / Q000175:diagnosis*; D006801:Humans; D007744:Obstetric Labor Complications / Q000175:diagnosis*; D011247:Pregnancy; D001747:Urinary Bladder Fistula / Q000175:diagnosis*; D014591:Uterine Diseases / Q000175:diagnosis*