Cadoret Florence, Brazet Edith, Sartor Agnès, Lacroix Isabelle, Casper Charlotte, Decramer Stéphane, Parant Olivier
CHU Toulouse, Pole de Gynécologie Obstétrique, Hôpital Paule de Viguier, 31059, Toulouse, France.
Centre Régional de Pharmacovigilance Midi-Pyrénées, 31000, Toulouse, France.
J Med Case Rep. 2020 Jul 19;14(1):115. doi: 10.1186/s13256-020-02425-6.
Fetal bladder rupture causing urinary ascites is uncommon. It is generally related to invasive fetal medicine procedures or obstructive disorders such as in posterior urethral valves in male fetuses. An exceptional case of spontaneous bladder rupture in a female fetus occurred in a pregnant woman treated with high doses of opiates in an intensive care unit. This unusual obstetric situation leads to discussion of the possible causes of fetal bladder rupture, its management, and the pediatric prognosis.
We report the case of a 30-year-old nulliparous black woman with a history of mesenteric cystic lymphangioma and multiple bowel resections leading to chronic malabsorption. During her pregnancy, our patient presented with an occlusive syndrome and major bilateral renal dilation. Urinary derivation resulted in iatrogenic bilateral ureteral perforation. Our patient thus presented with major uroperitoneum, bilateral pleural effusion and acute renal failure, treated by thoracic drainage and bilateral nephrostomy. Postoperative pain required treatment with level III analgesics. In this context, 5 days after morphine treatment introduction an enlarged fetal bladder was observed, followed 3 days later by voluminous fetal ascites. The diagnosis of spontaneous bladder rupture was suspected. After multidisciplinary discussion, expectant management was decided. At 31 weeks and 4 days gestation, our patient went into spontaneous labor with a subsequent vaginal delivery. The infant required resuscitation and paracentesis of ascites at birth. Her neonatal course was favorable with a simple urethral bladder drainage. Cystography at day 9 was normal. At 2 years of follow-up, the mother and the child have a normal course.
An iatrogenic origin of megacystis in a female fetus must be evoked in the event of maternal administration of high doses of opiates in the second part of her pregnancy. In our case, the megacystis was followed by spontaneous bladder rupture at 30 weeks of gestation, with a favorable maternal fetal issue.
胎儿膀胱破裂导致尿腹水并不常见。它通常与侵入性胎儿医学操作或阻塞性疾病有关，如男性胎儿的后尿道瓣膜。一名在重症监护病房接受高剂量阿片类药物治疗的孕妇发生了一例女性胎儿自发性膀胱破裂的罕见病例。这种不寻常的产科情况引发了对胎儿膀胱破裂的可能原因、处理方法及儿科预后的讨论。
我们报告了一名30岁未生育的黑人女性病例，她有肠系膜囊性淋巴管瘤病史且多次肠道切除导致慢性吸收不良。在她怀孕期间，患者出现了闭塞综合征和双侧严重肾积水。尿液引流导致医源性双侧输尿管穿孔。患者因此出现大量尿腹、双侧胸腔积液和急性肾衰竭，通过胸腔引流和双侧肾造瘘进行治疗。术后疼痛需要三级镇痛药治疗。在此情况下，在引入吗啡治疗5天后观察到胎儿膀胱增大，3天后出现大量胎儿腹水。怀疑为自发性膀胱破裂。经过多学科讨论，决定采取期待治疗。在妊娠31周零4天时，患者自然临产并随后经阴道分娩。婴儿出生时需要复苏和腹腔穿刺放腹水。她的新生儿病程良好，仅进行了简单的尿道膀胱引流。第9天的膀胱造影正常。在随访2年时，母亲和孩子情况正常。
如果孕妇在妊娠后期使用高剂量阿片类药物，必须考虑女性胎儿巨膀胱的医源性起源。在我们的病例中，巨膀胱在妊娠30周时随后发生自发性膀胱破裂，母婴结局良好。
