INJURY OF THE DISTAL URETER SECONDARY TO NORMAL VAGINAL DELIVERY: A COMPREHENSIVE REVIEW

Spontaneous ureteric rupture after a normal vaginal delivery is a rare occurrence, with about five cases reported in literature. We reviewed the literature with the aim to evaluate the causes of such an injury, presenting signs and symptoms, diagnosis, management strategies, outcome and follow up. Recognition and timely repair are critical to prevent long term complications and ensure good quality of life for the women suffering such a trauma. Clinicians must consider spontaneous ureteral rupture in the differential diagnosis for postpartum abdominal pain and flank pain when common causes have been ruled out. Diagnosis can be made with contrast-enhanced Computed Tomography scan and cystoscopy. In majority of cases, ureteral stenting or endoscopic repair are reasonable options for management. Copy Right, IJAR, 2024,. All rights reserved. …………………………………………………………………………………………………….... Introduction Rupture of the lower part of the ureter secondary to normal vaginal delivery is a highly unusual but serious complication often arising from trauma associated with the delivery process [1]. While most ureteric injuries are associated with surgical deliveries or gynecological procedures, the potential for such injuries during vaginal delivery must not be overlooked. The condition is characterized by a tear or rupture in the ureter, which can lead to significant renal and urinary complications if not promptly diagnosed and managed [2]. The rarity of this complication indicates that there is need for increased awareness among clinicians to ensure timely intervention [3]. This review provides a detailed examination of the incidence, etiological factors, clinical presentation, diagnostic approaches, treatment strategies, and outcomes associated with ureteric rupture following normal vaginal delivery. ReviewMethodology We searched PubMed for both indexed and non-indexed publications in English language, before June 30th, 2024 for this review. Studies that elaborately discussed the etiology, preventive strategies, postpartum recognition, investigations, and management of ureteric injuries during immediate and delayed postpartum period were included. Our searches yielded a total of 46 articles, which were screened to 14 as mentioned in our references and formed the basis of this review.