BACKGROUND: Severe obstructed labor with a pelvic fistula is associated with significant fetal and maternal morbidity and mortality. It is rare in the developed world due to access to health care and availability of cesarean section for labor dystocia. CASE: A 25-year-old primigravida in denial of her pregnancy due to a psychotic disorder experienced prolonged obstructed labor at home with fetal death, necrosis of her bladder and uterus, sepsis and profound neuropathy. Aggressive surgical and medical management, including hysterectomy and urinary diversion, resulted in survival and an enhanced potential for a good quality of life. CONCLUSION: Severe urogenital fistula secondary to prolonged obstructed labor can occur in a metropolitan area. In the setting of psychiatric disease, physicians must be prepared for the most remote clinical situations and complications.
BACKGROUND: Severe obstructed labor with a pelvic fistula is associated with significant fetal and maternal morbidity and mortality. It is rare in the developed world due to access to health care and availability of cesarean section for labor dystocia. CASE: A 25-year-old primigravida in denial of her pregnancy due to a psychotic disorder experienced prolonged obstructed labor at home with fetal death, necrosis of her bladder and uterus, sepsis and profound neuropathy. Aggressive surgical and medical management, including hysterectomy and urinary diversion, resulted in survival and an enhanced potential for a good quality of life. CONCLUSION: Severe urogenital fistula secondary to prolonged obstructed labor can occur in a metropolitan area. In the setting of psychiatric disease, physicians must be prepared for the most remote clinical situations and complications.