ruptured bladder

[Reha]

A friend of mine just had her second baby. It was a planned HBAC, but she ended up transporting and had a repeat cesarean.

After the surgery, the doc came in and told her that her bladder had ruptured, and that there is no way of knowing if that had happened before coming into the hospital, or after she had arrived. She was in labor at home for about 10 hours, and at the hospital for about 2 hours before her baby was born.

This is the first time I have ever heard of a bladder rupturing during labor. I did a little bit of researching online, and it seems like it is pretty rare, but when it does happen, it usually happens in conjunction with a ruptured uterus in a VBAC mother.

For midwives who work in the hospital setting: how common is a ruptured bladder? Have you ever seen it occur?

All of the midwives who I have asked have the feeling that OB nicked the bladder himself and didn't want to fess up.

She is a week postpartum now, and still has a catheter in (though she is home).

[mendomidwife]

I've done births for many years and have never seen a ruptured bladder. I have heard about it - but from what I understand, it is quite rare. It is also usually a medical emergency and can sometimes cause excessive bleeding.
I have heard on a number of occassions that the bladder is accidently cut during surgery.
The women should request a copy of the surgical report from the hospital medical records department.

Carla

[Reha]

I thought about suggesting she request her records, but can you maybe tell me (and I know this sounds really bad)...is it common for things to be fudged on medical records to protect doctors? Or, if he had indeed nicked the bladder on accident, the report would state as such? I just don't know why he would say that he's not sure if it ruptured at home or not, if he did in fact accidentally cut it and the report says as much?

There was definitely no situation of emergency while at home or at the hospital. She transported for maternal exhaustion and 'ftp'.

[mendomidwife]

Difficult to lie about it happening in surgery - because there is an assistant surgeon, surgical nurses, other staff in the operating room. The doctor would have much more to lose by trying to hide the mistake than to just admit it and deal with the consequences.
Not being completely honest with the patient and hope it disappears is more common. That is not to say it is never done (misrepresenting records) - but unlikely in my opinion. If it ruptured at home she would have had massive bleeding, pain and possibly even fetal death - did they rush her to section - or did she labor at the hospital for awhile? The type of repair he did might give the answer too - if it was nicked it would be straight forward - but I would think with a uterine rupture there would be more extensive damage requiring a lengthy repair, etc. All that would be in the operating notes.
It would very interesting to read the surgical report and the events leading up to surgery.
Carla

[Reha]

Originally Posted by mendomidwife

If it ruptured at home she would have had massive bleeding, pain and possibly even fetal death - did they rush her to section - or did she labor at the hospital for awhile? The type of repair he did might give the answer too - if it was nicked it would be straight forward - but I would think with a uterine rupture there would be more extensive damage requiring a lengthy repair, etc.

Are you referring about a uterine rupture here? They didn't mention anything to her about that. Just that her bladder had ruptured.

Thanks for all of the info!

[mendomidwife]

I was referring to bladder rupture.....it seems to me that if it happened at home, prior to the transfer - she would have had symptoms.

"Rupture of a uterine scar during labor with concomitant severe injury to the maternal bladder has been reported sporadically. Previously reported cases have been diagnosed under a variety of conditions, commonly at the time of repeat Cesarean delivery. A case of maternal bladder rupture diagnosed following forceps-assisted vaginal delivery after Cesarean is presented. Severe bradycardia developed suddenly in the second stage of labor."

[MsBlack]

I agree with mendomw--and add that if this 'so-called' ruptured bladder had occurred at home or during transport, it seems to me there most likely would have been pain BEFORE the rupture even occurred, as the bladder filled beyond it's holding point. I say this because in the absence of instrumental interference (whether forceps or scalpels), it is hard to imagine anything besides over-fullness of the bladder leading to its rupture--though other mws might supply information I lack on this point. So, if this mom were not in constant pain, then at least it seems she would experience sharp pain whenever the bladder/surrounding area were touched/jostled in any way (from the outside) during labor, prep for transport and transport itself.

This is surely a doc doing the cya dance. What a shame. Yes, records should be sought and carefully examined. Seems to me that while a doc is as human as anyone else and an accident of surgery could have occurred, nicking the bladder, and that this in itself I would not myself consider reason for a lawsuit...well, intentionally misdirecting this family concerning the origin of the injury most certainly WOULD BE, to me, a reason for a lawsuit.

[Mama2Xander]

Sometimes women get pelvic adhesions after a cesarean (or other abdominal surgery) and these can cause bladder problems... I wonder if something like that could have been related to what happened to your friend? Like if she had a particularly strong adhesion, or multiple adhesions, and it/they ended up tearing the bladder? I have no idea if this is actually possible, or common, just kind of thinking out loud here!

I have also seen severe bladder damage from a placenta percreta (Not that it sounds like your friend had that, just mentioning it).

ETA: Of course, it is entirely possible that it was caused during the c/s as well! I think it would definitely be worth getting the OR report - it is not always super helpful/legible/accurate - but it may give some clues as to what happened.

[crazy_eights]

I've seen a number of "nicked bladder" during c/sec and I would be very suspicious....ask for the operative report.