{"paper_id":"947daeda-407b-4da7-974e-39f2730b0a57","body_text":"Submit Manuscript | http://medcraveonline.com\nCase report\nWe are describing a case of 29 year un-booked female G3P1₊11L1 at \n35+1weeks of gestation, illiterate of low socioeconomic state reported \nto labour room in gasping condition. Before reporting to us she was \ngetting treatment from some untrained person and details of which are \nnot available. She gave history of increasing pain abdomen for 2 days \nfollowed by cessation of pain &fetal movements for 6 hours. She also \ngave past history of urinary incontinence for 2 years and on treatment \nby some untrained person at peripheral centre.\nOn examination patient was in irritable and having difficulty in \nbreathing. Her Pulse rate was 110/min, BP-100/60mmHg, gasping \nwith severe pallor. On per abdominal examination, two obvious \nabdominal lump seen with distinct gap in between as shown in \nFigure 1. Per vaginally os could not be felt. Fetal heart sound was \nabsent. USG facility is not available in labour room. Patient was in \nrespiratory distress and pallor was present. Intavenous fluids started. \nCatheterization was done and there was frank haematuria. Injectable \nantibiotics ceftriaxone, metrogyl started. Blood was arranged. \nCounselling and prognostication was done. Our provisional diagnosis \nwas ruptured uterus in obstructed labour so we planned for urgent \nlaparotomy under General anesthesia.\nPer operative tense distended bladder (15×12cm) in front of uterus \nas shown in Figure 2. Lower uterine segment could not be reached \n500ml urine aspirated. This aspirated urine was blood stained as shown \nin Figure 3. Fetus was old IUD (Intrauterine Death) in transeverse \nlie. Atonic postpartum haemorrhage occurred. Bilateral uterine artery \nligation & B-lynch suture done. Bladder again got distended in per \noperative period. Urosurgeon was called and he opened the bladder \nby giving incision and we saw that a big clot was inside bladder and \naround 500cc blood clot was evacuated from bladder. Suprapubic \ncatheterization was done along with continuous bladder irrigation. \nTwo units of blood were transfused. After surgery she could not be \nex-tubated because she was not able to maintain saturation. But there \nwas no bed available in ICU. So patient was kept on bag and mask \nventilation. Later on patient brought USG report showing bilateral \nhydro-ureteronephrosis with 8.5cm mass at urethral opening. Urea-\n208, Creatinine-12 Hemoglobin-9. She expired after 24 hours of \noperation due to ARDS and acute renal failure on chronic kidney \ndisease with anaemia with septicaemia. This patient died because \nshe was referred late and already in septicaemia and her history and \nexamination misleaded in diagnosis. USG Facility was not available \nin labour room. \nFigure 1 Abdominal inspection.\nFigure 2 Laparotomy.\nObstet Gynecol Int J. 2015;2(6):196‒197. 196\n©2015 Rani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License , which \npermits unrestricted use, distribution, and build upon your work non-commercially.\nA case with intra-vesical clot during pregnancy \nmimicking rupture uterus \nVolume 2 Issue 6 - 2015\nAnjali Rani, Nisha Rani Agrawal, Mamta \nKalpana Singh, Ononna Das, Asna Zehra \nNaqvi, Priyanka Tripathi \nDepartment of Gynecology and Obstetrics, Banaras Hindu \nUniversity, India\nCorrespondence: Anjali Rani, Assistant Professor, Department \nof Gynecology and Obstetrics, Institute of Medical Sciences, \nBanaras Hindu University, Varanasi, India, \nEmail \nReceived: August 09, 2015 | Published: September 10, 2015\nAbstract\nA case with acute intravesical haemorrhage with obstructed uropathy is very challenging \nto diagnose during antenatal period, especially during labour. Here we are reporting a \ncase with intravesical haemorrhage with obstructive uropathy in antenatal patient. Aim of \npresentation is awareness of this condition which is often difficult to differentiate from \nuterine rupture in obstructed labour. It can be diagnosed with emergency ultrasound if we \nhad kept a differential diagnosis.\nKeywords: intravesical clot, rupture, pregnancy\nObstetrics & Gynecology International Journal \nCase Report\n Open Access\n\n\nA case with intra-vesical clot during pregnancy mimicking rupture uterus\n197\nCopyright:\n©2015 Rani et al.\nCitation: Rani A, Agrawal NR, Singh MK, et al. A case with intra-vesical clot during pregnancy mimicking rupture uterus. Obstet Gynecol Int J. 2015;2(6):196‒197. \nDOI: 10.15406/ogij.2015.02.00060\nFigure 3 Aspiration of bladder.\nDiscussion\nIn this case, we cannot differentiate between intra-vesical \nhaemorrhage from ruptured uterus in obstructed labour because of \ntypical history of pain abdomen and two distinct lump as seen in \nobstructed labour. After catheterization frank haematuria was present. \nIt misleaded again for rupture uterus. Intra-vesical clot is very rare and \nwe could not think that it could be due to clot in bladder. 1 Sometime \npatients with plcacenta percreta can also present with haematuria. 2 \nIn this part of India rupture uterus is very common because women \ntry normal delivery from untrained dais with no proper back up and \nproper transport facility is not available. Timely referral of patient is \nnot there. Because of poverty and illiteracy people go to untrained \npersons and when patient is about to die and left with no money it is \nreferred to a tertiary care centre. These centres have so much workload \nthat many times bed is not available in the intensive care unit. If the \ndiagnosis was done with USG then so many treatments are available \nfor intra-vesical clot.1,3,4\nConclusion\nWhenever a patient with history of cessation of labour pain with \nhaematuria with pallor comes, we should first think of ruptured uterus \nin obstructed labour which needs emergency laparotomy. But we \nshould take detailed history and examination and investigations to \nconfirm the diagnosis. We should keep some bladder pathology as \ndifferential diagnosis. Urgent USG facility should be there in labour \nroom so that proper diagnosis can be done. The aim was to make aware \nthat sometime this type of condition can mislead us in diagnosis.\nAcknowledgments \nNone. \nConflicts of interest \nThe authors declare there is no conflict of interests.\nReferences\n1. Korkmaz K, Sahin H, Islim F, et al. A new treatment for clot retention: \nintravesical streptokinase instillation. J Urol. 1996;156(1):201.\n2. Gupta P, Pradeep Y , Goel A, et al. Hematuria: an unusual presentation of \nplacenta percreta. Urology. 2012;80(2):e13–e14.\n3. Bandari J, Dangle PP, Tennyson LE, et al. Large bladder clot-An unusual \npresentation of neonatal bilateral renal vein thrombosis-case report and \nreview of literature. Urology. 2015;pii:S0090–4295(15)00695-0.\n4. Bo J, Yangyang Y , Jiayuan L, et al. Evaluation of bladder clots using a \nnonsurgical treatment. Urology. 2014;83(2):498–499.","source_license":"CC0","license_restricted":false}