A Case with Intra-Vesical Clot during Pregnancy Mimicking Rupture Uterus

A case with acute intravesical haemorrhage with obstructed uropathy is very challenging to diagnose during antenatal period, especially during labour. Here we are reporting a case with intravesical haemorrhage with obstructive uropathy in antenatal patient. Aim of presentation is awareness of this condition which is often difficult to differentiate from uterine rupture in obstructed labour. It can be diagnosed with emergency ultrasound if we had kept a differential diagnosis.

intravesical clot, rupture, pregnancy Obstetrics & Gynecology International Journal Case Report Open Access A case with intra-vesical clot during pregnancy mimicking rupture uterus 197 Copyright: ©2015 Rani et al. Citation: 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. DOI: 10.15406/ogij.2015.02.00060 Figure 3 Aspiration of bladder.

In this case, we cannot differentiate between intra-vesical haemorrhage from ruptured uterus in obstructed labour because of typical history of pain abdomen and two distinct lump as seen in obstructed labour. After catheterization frank haematuria was present. It misleaded again for rupture uterus. Intra-vesical clot is very rare and we could not think that it could be due to clot in bladder. 1 Sometime patients with plcacenta percreta can also present with haematuria. 2 In this part of India rupture uterus is very common because women try normal delivery from untrained dais with no proper back up and proper transport facility is not available. Timely referral of patient is not there. Because of poverty and illiteracy people go to untrained persons and when patient is about to die and left with no money it is referred to a tertiary care centre. These centres have so much workload that many times bed is not available in the intensive care unit. If the diagnosis was done with USG then so many treatments are available for intra-vesical clot.1,3,4

Whenever a patient with history of cessation of labour pain with haematuria with pallor comes, we should first think of ruptured uterus in obstructed labour which needs emergency laparotomy. But we should take detailed history and examination and investigations to confirm the diagnosis. We should keep some bladder pathology as differential diagnosis. Urgent USG facility should be there in labour room so that proper diagnosis can be done. The aim was to make aware that sometime this type of condition can mislead us in diagnosis. Acknowledgments None. Conflicts of interest The authors declare there is no conflict of interests.

1. Korkmaz K, Sahin H, Islim F, et al. A new treatment for clot retention: intravesical streptokinase instillation. J Urol. 1996;156(1):201. 2. Gupta P, Pradeep Y , Goel A, et al. Hematuria: an unusual presentation of placenta percreta. Urology. 2012;80(2):e13–e14. 3. Bandari J, Dangle PP, Tennyson LE, et al. Large bladder clot-An unusual presentation of neonatal bilateral renal vein thrombosis-case report and review of literature. Urology. 2015;pii:S0090–4295(15)00695-0. 4. Bo J, Yangyang Y , Jiayuan L, et al. Evaluation of bladder clots using a nonsurgical treatment. Urology. 2014;83(2):498–499.