#Childbirth trauma

[ijcimr]

Combined cervical laceration and bladder rupture: a case report of an unusual complication of precipitated labor by Dr Fatemeh Darsareh in International Journal of Clinical Images and Medical Reviews 

Abstract

Cases of bladder rupture have been rarely reported following vaginal childbirth. To the best of our knowledge, however, no cases of combined cervical laceration and bladder rupture have been reported to date. We present the first case of a 31-year-old woman with gestational diabetes who suffered a combined cervical laceration and bladder rupture after childbirth. Precipitated labor caused by oxytocin induction resulted in vaginal and cervical lacerations. The bladder rupture was confirmed by cystography. A team of obstetricians and urologists performed the laparotomy. The patient was kept under observation for two weeks before being discharged with no serious complications.

Keywords: Bladder rupture; Cervical lacerations; Precipitated labor; Childbirth trauma; Case report.

Introduction

Spontaneous bladder rupture following normal vaginal delivery is a surgical postpartum emergency. Previous cesarean section, vacuum/forceps-assisted vaginal deliveries, and distended bladder compressed by engaged head in birth canal are all risk factors for bladder injuries in healthy parturient women 1. Cases of bladder rupture, accompanied by uterine rupture, have been rarely reported following vaginal birth after cesarean section 2. To the best of our knowledge, however, no cases of combined cervical laceration and bladder rupture have been reported to date. We present the first case of spontaneous bladder rupture with cervical laceration after a precipitated vaginal delivery.

Case Presentation

A 31-year-old, G2P1L0D1, woman with gestational diabetes, was admitted to our maternity ward at 38 weeks of pregnancy for elective induction of labor to terminate her pregnancy.  She had a history of preterm birth and was a known case of minor thalassemia. The induction of labor began at 5:00 a.m. with oxytocin, and contractions began approximately two hours later. Table 1 depicts the progress of labor. During her labor, the patient urinated once. Finally, at 10:40 a.m., she gave birth to a baby boy weighing 3700 grams with an Apgar score of 7/9.  Excessive vaginal bleeding was observed following placental expulsion. The examination revealed an extensive laceration in the vagina and cervix that was repaired by the obstetrician and midwife. The patient was catheterized and was being closely monitored. A urologist was consulted due to the oliguria and hematuria (100 cc output with gross hematuria within 5 hours of childbirth). Cystography, as recommended by the urologist, revealed the bladder rupture. The patient was prepared for a laparotomy immediately. The laparotomy was performed by a team of obstetricians and urologists. Several hematomas were discovered in the uterine body and the broad ligament that the team decided not to manipulate because it did not grow during the surgery. A bladder rupture was found at the dome of bladder that was repaired in two layers. One pack cell unit and two FFP units were transfused. A peritoneal drain was placed posterior to the bladder and the skin incision was closed in layers. The patient was observed for two weeks. The result of the ultrasound revealed the shrinking of the hematoma. The blood and renal tests were normal. The catheter was removed after 2 weeks and the patient was discharged.

Table 1: The progress of labor

Discussion

Precipitate labor is defined as the expulsion of the fetus within three hours of the start of contractions. Few studies have found that precipitated labor is harmful to both the mother and the newborn. Precipitated labor, which is most commonly associated with placental abruption and induction of labor, is a significant risk factor for maternal complications 3. Maternal morbidities reported included extensive birth canal lacerations, uterine rupture, placenta retention, the need for revision of uterine cavity, post-partum hemorrhage, and blood transfusions 3,4. The lower urinary tract's anatomic proximity to the reproductive tract predisposes it to iatrogenic injury during obstetric procedures. The bladder and lower ureter are two of the most commonly involved organs. Because the dome of the bladder is the weakest area, most bladder ruptures occur through the peritoneal cavity 5. In our case, in addition to deep vaginal tears and extensive cervical laceration, bladder rupture occurred, but the diagnosis was delayed by a few hours. Given the nonspecific clinical features of bladder rupture, the diagnosis should be approached with caution. Oliguria and gross hematuria after a traumatic childbirth increase the likelihood of bladder rupture. In such cases, a cystogram is thought to be the best method for early detection.

In our case the patient had induced labour with oxytocin. The use of oxytocin to induce labour can result in tachy-systole and thus shorter deliveries. So in our case we believe that the power of uterine contractions and quick descent of passenger (3700 grams fetus) were the main risk factors of precipitated labour and the complications accompanied with it. A distended bladder during labor, particularly in our case, where the fetus descended quickly, could also be a factor in bladder rupture. Although the patient urinated normally during labor, it was critical to ensure that the bladder was empty, especially during the active phase of labor, to avoid bladder damage.

CONCLUSIONS

Bladder and cervical rupture should be considered, after precipitated vaginal delivery. When there is gross hematuria, a urinary catheter should be inserted to monitor the hematuria and urine output. If the hematuria persists and other associated symptoms appear, cystography is a useful tool for determining the severity of the bladder injury and determining the cause.

Funding

This study received no specific funding from public, commercial, or not-for-profit funding agencies.

Conflict of Interest

Authors had no conflicts of interest to declare.

Patient consent

Obtained.

For more details: https://ijcimr.org/editorial-board/ 

[mayasaura]

HANG ON. WAKE WAS SNEAKING AROUND INSIDE HARROW'S HEAD FOR NINE FUCKING MONTHS.

Throw another one into the mix permeating Harrow's soul lads. This little witch can fit so many subliminal influences into her

[veerbles]

we all heard about 'jordie lives' fics, but what about 'kaz never explicitly says his mother is dead, so what makes you think that she is' ones?

[rowanisawriter]

🫧

[sandinthepipes]

As somebody who watched Bridgerton last week for the first time, I’m still wandering why everybody is making a fuss and being horny about it with the third season, which was ok, but not season two, which, as a lesbian, I can confidently say, if I saw Anthony looking at me through the legs I’d be as straight as a pole. Season two had everything. The drama, enemies to lovers, the pine, the weird polygon love shape, the pants-staining cliffhanger. That is peak romantic novel, I don’t care what you say

[shadowgirl-noa]

So glad @redspringstudio keeps us well-fed as we wait for the full release. Here's Lyssa's flower- the Hairy Buttercup! This style was harder to replicate for me, sadge

Predictable? Maybe. But if the boot fits...

[ladysternchen]

Something unrelated to Tolkien for a change…

🌹each woman a rose💐

Violence against a human being is a crime.

Women before, during and after birth are human beings (and again very slowly for doctors and a few nurses and midwives as well: YOUNG. MOTHERS. ARE. HUMAN.BEINGS!)

Violence during pregnancy and during or after childbirth is a crime.

It is not ‘necessary’.

Forcing a woman to stay in a position in which she cannot bear the pain (a pain, moreover, that scientists put down as one of the most severe that a human being can endure) is an act of violence.

Shaming and belittleing a birthing woman is an act of violence.

Cutting a birthing woman open without her valid consent -that is consent given after the woman made an informed decision- is an act of violence.

Pressuring a woman to give up her right to make decisions concerning HER OWN body in potential favour of the unborn child is an act of violence.

Ignoring a woman’s ‘STOP’ is an act of violence and -if that includes your hands up her vagina or fumbling around with her breast trying to stuff a bleeding nipple into a screaming newborn’s mouth- sexual assault.

Invalidating a woman’s experience is an act of violence.

Yes yes yes, I know. Sometimes there is an emergency… yeah, you know, if you have time enough to say to the concerned nurse ‘oh, she’s not even im pain, she’s just acting the diva.’ you have enough time to say ‘dear, I know this is terrible frightening and you’re in pain, but we need to move fast now to make sure you and baby are ok. We’re taking good care of you. It’ll be over soon’- that makes the difference between a difficult birth and a traumatic one.

And besides, 1/3 of all mothers describe birth as being traumatic. Not 1/3 of all births include emergencies. So stop using that stupid argument to rectify you bad work.

You’re stressed, I get it. We have a global healthcare crisis. I am truly sorry for that. But if you’re so stressed it makes you feel that violence is needed to make the system work, then it’s probably time to step back.

[vi0light]

𝐜𝐥𝐨𝐬𝐞𝐝  𝐬𝐭𝐚𝐫𝐭𝐞𝐫  ;  @sacrificeds   ⟳   𝙰𝙲𝚃 𝙸𝙸   ;   under  a  shaded  canopy  in  the  gardens  of  highgarden  ,  a  server  is  lingering  near  by  ready  to  replenish  their  glasses  .   

  silence  lingers  between  them  &  she  steals  a  glance  ;  two  scions  of  a  dynasty  bounded  by  the  strangers  icy  graze  .   there  is  no  true  recovery  ,  whether  the  brush  be  upon  dragonback  or  the  birthing  bed  ;  two  battlefields  of  differing  immensity  ,  yet  similar  in  their  casualties  .  they  are  the  fortunate  ones  ,  or  so  concerned  tones  remind  them  .  though  some  wounds  will  never  heal  &  as  lilac  orbs  observe  familial  features  ,  rhaenys  ponders  if  he  has  discovered  that  morsel  of  knowledge  yet .  she  could  utter  the  wisdom  ,  enough  time  has  passed  since  her  own  dalliance  with  the  stranger ,  long  enough  for  the  adage  to  become  apparent  .  alas  ,  she  knows  better  than  most  how  intolerable  the  soliloquies  of  pity  can  be  and  so  she  bites  her  tongue  .   ❛    i  do  not  mean  to  be  disparaging  to  our  host  but  [ ... ]  the  overwhelming  aroma  of  roses  is  making  me  miss  the  stench  of  blackwater  rush .   do  you  think  the  tyrell's  know  there's  more  flora  in  the  world  than  just  the rose   ?   ❜

[fiction-quotes]

I think this to myself even though I love my daughter. She and I have shared the same body. There is a part of her mind that is part of mine. But when she was born, she sprang from me like a slippery fish, and has been swimming away ever since. All her life, I have watched her as though from another shore. And now I must tell her everything about my past. It is the only way to penetrate her skin and pull her to where she can be saved.

  —  The Joy Luck Club (Amy Tan)

[imaginmatrix]

this is perhaps more extensive than a prompt, but my percabeth hc that I feel like is NEVER written and have always wanted to see is Annabeth struggling w infertility/miscarriage. You mean to tell me Hera wouldn’t take the chance to make their lives hell again?

Unfortunately for many personal reasons, I’m not comfortable writing about those topics myself

But it’s good angst fodder, for sure haha

I don’t necessarily think that would be the case, as Hera is not the only fertility/child birth goddess— the domain has belonged to a LOT of them, and I feel like Artemis or even Aphrodite would just. cancel out any anti-child hexes lol.

But I CAN see the percabeth wedding day going horrifically wrong, in the funniest ways possible. Annabeth ripping the bottom of her wedding dress off to better fight a gorgon or something. Could be fun!

[soupedepates]

TW religious trauma, misogyny, mention of death in childbirth

I look at my son running to you, and mother is giggling because Esprit can't run properly and Pie tries to help him. They are like twins. Mother gazes at you, dreaming about the Lord knows what, a tender grin on her face.

Of course, you go and raise the boys in your arms. I bet you reek of transpiration and other woodly smells. But they love you more than me. Me who birthed one of them. Me who nursed one of them. Me who stayed awake all night long to care after them. You never did any of that. Father insisted that childcare isn't your job. Mother still has you do the housework, the true battle a woman shall wage, but father treats you like a man. Since you're a "knight". You will never be a man. You are not even a woman anymore.

"What a shame Tomyris can't marry, she would have done a wonderful mother, don't you think Prudence?"

I quietly nod.

"And children just love her, what a shame she can't be a mother. I remember when she was so tiny, and so eager to... No, the Lord works in mysterious ways, but still, what a shame."

I let her go at her rambling. Why is she talking about you, when I am the true first girl of the house? I married a good man. I even had a son. I am already pregnant with my second child. I cook, I clean, I stitch and sew, I am the perfect housewife and I make it look effortless. Why is mother seemingly more infatuated with your "achievements" than with the honours I bring to the family? It doesn't use to be like that. I used to be mother's favourite. I used to be doted on by everyone.

My mother-in-law said while I was suffering during labour that the greatest honour a woman shall have is dying in childbirth by giving her husband a boy.

"It's in the great scheme of things", I say while glaring at you playing with the boys, blissfully unaware of everything. "Fighting suits her. Bridehood wouldn't."

My own wedding-dress was your hand-me-down. You should have married in it. The bitter taste remains on my tongue. Why were you even born? You make no sense. You come closer, holding your brother and your nephew like treasures. How come can you be so grotesquely delicate at time?

"I think they belong to you", you smile with that stupid attitude you learnt from the men.

"How was practice, dear?"

"It went alright, mother", you say as you sit. "I'll still have to watch a group of girls who convinced their parents to let them sleep under the stars, so... Don't wait for me for dinner."

"We sure won't", mother tells you with a glimpse of disappointment you obviously can't catch.

"Is something wrong, Prudence?"

I raise my head to face you. You won't understand. You can't manage to even be a human person. You stare at me with round eyes, and I remember each and every time you got scolded for not looking at people. I know that behind that hairless face there is a ticking time bomb, waiting to implode, and it isn't that I am scared of you, it is just that father and mother are ready to find an excuse for you. It was this way when we were girls, it is still today. You can't stay still, you can't read a room, you can't take a hint, you, you... I am so disgusted by the look of you. Blissfully unaware. How dare you?

"Nothing. I guess I am just tired."

Pardon me, Lord. I shall not hate.

I sometimes pray you go to Hell.

[lucreziasredwyne]

who: @arronlannister when and where: the princess meredyth lannister's birthing chamber, some long hours into the night; the atmosphere is busy, chaotic even, and lucrezia redwyne is one of the women attending to the princess in her hour of greatest need. both are aware of the severity of the situation, despite meredyth slipping in and out of consciousness.

there came a sound that was animalistic as it's very core, the sound of bloodcurdling scream one would only think to hear in myths and legends, the most far off stories from beyond the wall: or the common birthing bed, when the gods had decided one's time had come. regardless of how many times the lady of the arbor attempted to bring her to some form of consciousness, there was no denying the harrowing of her breaths and the increasing whiteness of her skin; the lingering shadow of death which had once again clasped her around the neck.

the screaming, the howling, seemed to only add to the heat in the room: and yet, one touch of meredyth was enough to send a feeling of ice to spread through lucrezia's being. for she felt the impending coldness in the limpness of her limbs, and the way in which warm orbs seemed to roll backward; the hours had blended into one, strenuous stretch of time. the people of the west wanted their second prince of fair isle.

lucrezia could see it in the way both maesters and midwives looked upon the situation, with a calculating look in their eye; as though this were some formula, some sum of a lump of gold.

they had paid for meredyth rowan, and they would get what they had paid for. a hand rested upon her closest friend's clammy face, quietly muttering words of endearment in the moments of consciousness, assurance that all would be well and it would be over soon. the babe would turn into the correct position, and could once again push - push to relieve herself of the bone crushing pressure which no doubt felt as though it would split open her pelvis.

but in those moments of no consciousness, when the eyes rolled back again and the body seemed to go into some state of limp, stiff, shock, lucrezia muttered prayers through eyes that were blind with tears, what small amounts of kohl she had worn earlier in the day running down her cheeks. her prayers were feverish, frantic, nothing akin to the steadiness she had uttered at her own mother's birthing bed: even when her voice shook. there came the quiet request for water to keep the princess cool - and the reminder that her husband had asked for her wellbeing.

and in that simple, small request laced with falsehood, lucrezia redwyne made the biggest mistake of her life. unclasping a clammy hand from mimi rowan's as she was being propped up, lucrezia assumed they would be trying to stir her awake by sitting her up - by trying another position, and allowing the natural position of a woman to take hold. she stepped out into the foyer, her mind blurred with the sounds of meredyth's screams and that of her own mother's over a decade ago; and as she walked, she did not realise the bowl of water she carried had spilled everywhere.

because there had been a scream. a different scream. and what she pushed her way back into, was a bloodbath. her gown pushed over her stomach, baring her before the maesters - lucrezia almost wanted to scream at them to look away, to force their heads back to crash against the candelabra again and again. but it was the open flesh of the stomach which she saw first, and a bloodied, screaming babe which was wrapped in a blanket.

why was she silent? why could she see the insides of her hycathith? why could see her mimi?

the bowl of water came crashing onto the ground and her hand moved to clasp over her hand, masking a gasp that was half shriek of shock, and half a mournful cry. like a wounded dog. she did not even feel the king's rage barge by her, suddenly becoming part of the furniture. a shadow on the wall - and yet, her hand remained clasped over her mouth the entire time, to the point she began to bite down on it as her breathing tightened. to stop from her own bloodcurdling sobbing from coming out of her chest.

and then the anarchy began.

[balkanradfem]

Do honor killings happen in the Balkans?

I have to admit I don't have any information on this, as far as I know the honor killings are a product of islamic oppression of women, and there are muslims in the balkan regions, so I would be surprised if there were no honor killings here. I have not, personally, heard of any happening near me, but if someone else has more correct information on this, please add to the post.

[imfromthemiddlekingdom]

Miriel chose to stay dead, repeatedly.

Look if you’re repeatedly pressuring a depressed woman who had postpartum depression to come back just to have more kids without letting her work through her problems for a bit you’re responsible for her very anger filled hateful /spiteful reply that “fine I guess I will just stay dead Finwë!!!”.

You don’t pressure a depressed person to ‘just be happy’ so why would you pressure someone who died due to postpartum to come back JUST to do it ALL OVER AGAIN???

And the whole ‘she chose to stay dead repeatedly!!!’ Yet when she was offered a chance to come back after Finwë died she did so she obviously didn’t wish to stay dead forever and her response to Finwë and the Valars repeated pestering could be chalked up to frustrated spitefulness cuz god knows how many times normal, non depressed, people say spiteful petty shit just to get people to back off and have rest so god forbid a dead woman who died after postpartum say anything she didn’t mean.

[mother-rhoyne]

GRR: So Jon is watching over Dalla's childbirth in the midst of a battle, a birth that ends in tragedy and that neither he, helpless swordsman, nor Val, her sister at her side, can change. It draws a fascinating parallel with his own birth, of a woman of the north in a bed of blood, a protector who cannot protect her, and a woman who can only watch over her child. Has he ever been closer to Ned than in this moment? Will he ever know it?

GRR: Mh, better keep that scene off-page

[branwendaughterofllyr]

I am once again having thoughts