title: Vesicovaginal fistula formation after cervical cerclage mimicking premature rupture of membranes.
abstract: BACKGROUND
  Women with a history of pregnancy loss in the second trimester are often diagnosed with cervical insufficiency and are treated with cervical cerclage. We present an unusual complication of this procedure that mimicked preterm rupture of membranes.
  
  
  METHODS
  A 38-year-old woman with a history of cervical conization, loss of a triplet pregnancy at 22 weeks, and one early spontaneous abortion underwent cervical cerclage placement during her third pregnancy. She developed an intermittent vesicovaginal fistula 2 weeks after the procedure that mimicked preterm premature rupture of membranes. Only after the urine loss became heavy and continuous 10 weeks later was the diagnosis of vesicovaginal fistula made.
  
  
  CONCLUSIONS
  Obstetricians should recognize that cerclage placement may result in unusual urinary tract injury.
authors.affiliation: Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Obstetrics and Gynecology, Washington University in St. Louis, Missouri 63110, USA. WALLL@wustl.edu
authors.forename: L Lewis
authors.initials: LL
authors.lastname: Wall
authors.forename: Fareesa
authors.initials: F
authors.lastname: Khan
authors.forename: Stephanie
authors.initials: S
authors.lastname: Adams
mesh_terms: D000328:Adult; D023802:Cerclage, Cervical / Q000009:adverse effects*; D002585:Cesarean Section; D003937:Diagnosis, Differential; D005260:Female; D005322:Premature Rupture of Fetal Membranes / Q000175:diagnosis; D006801:Humans; D007752:Obstetric Labor, Premature / Q000517:prevention & control*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D011296:Prenatal Diagnosis; D053832:Surgical Tape / Q000009:adverse effects*; D014719:Vesicovaginal Fistula / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology