Damage to the wall of the bladder in pregnant women

Damage to the wall of the bladder can occur with improper management of labor, when the fetal head, if its size does not match the size of the pelvic cavity, is long in the same plane of the small pelvis, which leads to increasing ischemia of the tissues of the bladder or urethra and vaginal walls in the inner surface pubic articulation of their subsequent necrosis and the formation of bladder-plugged fistula. Only urethral tissue (all or part of it) is exposed to necrosis. In this case, with a whole bladder, urinary incontinence appears. Urinary incontinence can also be the result of crushing of the muscle membrane of the urethra while maintaining its lumen and the integrity of the vaginal mucosa. This pathology occurs in the case of a prolonged course of childbirth in the absence of medical supervision or an extremely poor qualification of the person conducting the birth. For several million genera in the Ukrainian SSR, fistulas of this genesis did not occur. Violent damage to the bladder occurs due to a violation of the technique of delivery operations: embryotomy, the application of obstetric forceps, vacuum extraction of the fetus and extraction of it during foot and pelvic insertions. Except in rare cases when damage to the bladder is an accident (slipping of a cutting tool), its injury occurs when the conditions or technique of the delivery surgery are violated and indicates insufficient qualification of the doctor who carried out the delivery. Fistulas of traumatic origin are diagnosed immediately after the end of the operation with catheterization of the bladder, which is an obligatory final stage of surgery. If there is an extensive rupture of its tissues, it is not possible to get urine or drops of it follow, in color resembling diluted blood. If the hole in the tissues of the bladder is pebby, a little urine flows out, intensely stained blood. To clarify the diagnosis, it is necessary to introduce a solution of furacilin into the bladder, which will flow freely from the vagina. Examining the vagina, you can clarify the location and magnitude of tissue damage, as well as their nature (edema, hemorrhage, crushing, necrosis), which is very important for deciding on the volume of subsequent surgery. In all cases, when possible, cystoscopy is necessary to determine the location of the ureteral orifice in relation to the edges of the gap. In the presence of systemic damage to the tissues of the genital organs, intestine and bladder, it is necessary to restore the integrity of the intestine, bladder and only then other wound surfaces. If there is a linear incision or puncture of the bladder, the integrity of its wall can be restored without excising the edges of the wound, immediately after the diagnosis. Crushed tissue must be removed. After suturing the rupture site, it is necessary to check the patency of the ureters using chromocystoscopy and the thoroughness of suturing the brine. At the end of the operation, a permanent catheter for urine diversion is introduced into the bladder for 6-8 days . In case of extensive ruptures after restoration of the integrity of the bladder, urine is diverted through the ureter catheters. In the presence of necrosis of the vaginal wall and bladder, sequestration of dead tissue occurs on the 3-5th day with the expiration of urine in the vagina. The size of the fistulous opening becomes stable after rejection of all dead tissue. Suturing of such fistulas is done no earlier than 2-3 months after birth.

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