An Emergent Cesarean and Ureter Injury

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A 34 year old G2P1 at 40w4d gestation presented to the hospital with painful contractions.

She had multiple sclerosis (optic neuritis - now in remission) and history of a previous C-section.

Upon assessment by the OB team she was admitted for TOLAC.

As labor progressed the anesthesia team performed a CSE for analgesia.

She required push pressors immediately after, but her blood pressure recovered and remained at normal levels.

More time passed and labor was slow to progress. She also began to experience decels. The patient and husband were counseled on and agreed to a C-section.

The epidural was loaded with 2% lidocaine and a level was obtained.

The infant was delivered via C-section.

Upon examination of the uterus it was noted the incision extended far laterally to the left uterine artery resulting in additional blood loss. The artery was repaired, although dense adhesions impaired visualization. The ureter was never seen. EBL 2000.

Post operatively, after rising creatinine and further counseling, she agreed to a pyelogram.

The patient received a nephrostomy tube and was to follow up for ureteral reconstruction surgery.

She underwent nephrostomy tube changes and had a failed capping trial where she developed a UTI.

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