Herken Julia, Uerlings Vincent, Zundel Sabine, Aichner Jonathan, Hodel Markus
Department of Obstetrics and Gynecology, Lucerne Cantonal Hospital, Luzern, Switzerland.
Department of Pediatric Surgery, Children's Hospital Lucerne, Luzern, Switzerland.
Case Rep Perinat Med. 2024 Apr 29;13(1):20230034. doi: 10.1515/crpm-2023-0034. eCollection 2024 Jan.
Fetal bladder rupture is rare and mainly caused by lower urinary tract obstruction (LUTO). Our case report describes a rupture at a gestational age of 31 weeks following high-dose maternal opioid exposure during intensive care treatment. Opioids perturb the interplay of afferent and efferent signals between the bladder, urethra, and the central nervous system (CNS) which is crucial in contributing to urinary retention. They rapidly cross the human placenta, affecting also the fetus. To date, there is no clear proof of the connection between maternal opioid treatment and fetal bladder rupture, but the association seems to strengthen.
A 18-year old first Gravida at 31 weeks of gestation developed a severe sepsis with progressive hypoxic lung failure and need for intubation. During the ICU-treatment, several opioids were administered for sedation and pain relief. Four days after induction of opioid treatment the ultrasound revealed a decompressed fetal bladder, hematoma and significant ascites. Fetal bladder rupture with urinary ascites was suspected. A caesarean section was performed at 33 weeks of gestation due to massive fetal urinary ascites, fetal deterioration and imminent abdominal compartment syndrome. Adequate ventilation and circulation could only be established after percutaneous drainage of 350 mL of abdominal fluid, that was confirmed to be urine. A defect of the bladder was confirmed by ultrasound. On the fifth day of life, the bladder was closed surgically by pediatric surgery.
Growing awareness of the possible connection between maternal opioid therapy and fetal bladder rupture is necessary to plan follow-up ultrasound examinations to assess the fetal situation.
胎儿膀胱破裂较为罕见，主要由下尿路梗阻（LUTO）引起。我们的病例报告描述了一例在重症监护治疗期间母亲大剂量使用阿片类药物后，孕31周时发生的膀胱破裂。阿片类药物扰乱了膀胱、尿道和中枢神经系统（CNS）之间传入和传出信号的相互作用，这对导致尿潴留至关重要。它们能迅速穿过人胎盘，也会影响胎儿。迄今为止，尚无明确证据证明母亲使用阿片类药物治疗与胎儿膀胱破裂之间存在关联，但这种关联似乎在增强。
一名18岁初产妇，孕31周时发生严重脓毒症，伴有进行性低氧性肺衰竭，需要插管。在重症监护病房治疗期间，使用了多种阿片类药物进行镇静和止痛。阿片类药物治疗开始四天后，超声检查显示胎儿膀胱减压、血肿及大量腹水。怀疑胎儿膀胱破裂伴尿腹水形成。由于大量胎儿尿腹水、胎儿状况恶化及即将发生腹腔间隔室综合征，在孕33周时进行了剖宫产。经皮引流350毫升腹腔积液（经证实为尿液）后，才得以建立充分的通气和循环。超声检查证实膀胱存在缺损。出生后第五天，小儿外科对膀胱进行了手术修补。
有必要提高对母亲使用阿片类药物治疗与胎儿膀胱破裂之间可能存在关联的认识，以便计划进行超声检查随访以评估胎儿情况。
