Obstetrics / Caesarean section
Ureteric injury following Caesarean section
Eleanor was booked for an elective Caesarean section in her second pregnancy, but went into labour before this. Delay in getting into theatre resulted in the Caesarean being performed in the second stage of labour and profuse haemorrhage occurred from a lateral tear in the uterus. Ureteric obstruction and fistula were later diagnosed. PMS concluded that the delay in going to theatre was a breach of duty, which increased the risk of complications. However, a lateral tear in the uterus into the broad ligament is a recognised complication of Caesarean section in the second stage of labour, and this can cause profuse bleeding from large branches of the uterine artery and vein. It can be difficult to identify the ureter in this situation and dissection can provoke more bleeding. The obstetrician's priority was to stop the bleeding and save the patient's life, but it was a breach of duty that he did not consider the risk of ureteric injury and arrange a CT urogram. Delay in diagnosis and treatment resulted in the development of a fistula and the need for open surgery to re-implant the ureter.
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