Uncommon Yet Profound Challenges in Modern Obstetrics: The Risk of Urethral and Bladder Rupture Following Instrumental Deliveries

Introduction: Bladder rupture and urethral injury during vaginal delivery are rare but serious complications, with an incidence of <1 in 10,000 births.These injuries are more commonly seen in cesarean sections, with vaginal delivery cases being exceedingly rare.Risk factors include prolonged or obstructed labor, macrosomia, instrumental delivery, and inadequate bladder emptying.Complications can include hematuria, peritonitis, urinary incontinence, and fistula formation.Case report: A 27-year-old multiparous woman (P2L2) was referred post-delivery with urinary retention.Her first stage of labor was uneventful, but she underwent forceps-assisted vaginal delivery due to fetal distress during the second stage.She developed atonic postpartum hemorrhage and was managed conservatively.Examination revealed a tear in the anterior vaginal wall, with the Foley catheter visibly exiting through the vaginal canal.Surgical exploration confirmed a 4 × 4 cm anterior vaginal wall tear, urethral disruption, and a defect at the bladder base.She underwent successful bladder repair, vesicourethral anastomosis, and vaginal wall reconstruction.Discussion and conclusion: This case underscores the potential for significant urogenital trauma during instrumental deliveries.Improper forceps application may increase the risk of bladder and urethral injuries.Early recognition and prompt surgical intervention are essential to prevent long-term morbidity.A multidisciplinary approach involving obstetricians, gynecologists, and urologists is crucial to ensure comprehensive management and optimal recovery.