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Obstetric anesthesia management of a parturient with didelphys uterus and bladder augmentation
Abstract Number: F2D-6
Abstract Type: Case Report/Case Series
A 30 year old G2P1 at 37w5d with a history of didelphys uterus and bladder augmentation presented with PROM. She had a history of bladder extrophy which was repaired in childhood via an appendicovesicostomy (APV). This pregnancy was noted to have a breech presentation within the left uterus. Taking into consideration her PROM presentation and prior cesarean delivery the decision was made to perform a repeat C/S.
The pre-operative planning included an accelerated inter-disciplinary discussion between Obstetrics, Urology and Obstetric anesthesia teams which included a review of the physiology present with the amalgamation of these two rare conditions. The decision was made by the anesthesia team to proceed with a CSE technique; the surgical field was prepped taking into consideration that the suprapubic catheter was within the field. The urology team examined the APV and passed a 12Fr catheter to drain and irrigate the bladder augment and a foley catheter was left in-situ for the duration of the operation. The obstetric team made a vertical incision along the existing classical incision scar. The bladder augment was adherent to the anterior abdominal wall; however, a classical hysterotomy was performed without complications. A viable female infant was delivered with APGAR scores of 8 and 9. Subsequently, the urology team verified the integrity of the bladder augment by back-filling with sterile saline.
Didelphys uterus is among the rarest of the Mullerian duct anomalies (MDA)1. The condition itself is often asymptomatic but has associations with renal and urologic anomalies (consistent with our patient’s history)2. Our patient is unique as she presented with a combination of didelphys uterus and bladder augmentation. Cesarean delivery in this patient presented an increased risk of bladder or ureteric injury which prompted the presence of a urologist as part of the delivery team.
1.Grimbizis GF et al. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reproduction Update. 2001;7(2):161-17
2.Tzortzis V et al. Feasibility and safety of radical cystectomy under combined spinal and epidural anesthesia. Can Urol Assoc J. 2015;9(7-8):E500-4.