Manifestation of Spontaneous Rupture of the Urinary Bladder in Pregnancy: A Systematic Review of the Literature

Abstract

Spontaneous rupture of the urinary bladder (SRUB) during pregnancy is a potentially fatal event that necessitates immediate surgery. The aim of this systematic review is to determine the symptoms, causes, associated factors, and prognosis of SRUB in pregnancy. We searched the literature from inception until December 2022 using the Cochrane Central Register, PubMed, EMBASE, ProQuest, Scopus, and Google Scholar. Articles not in English and those unrelated to the topic were excluded. The JBI Critical Appraisal Checklist for case reports was employed for the risk of bias assessment. The search strategy yielded 312 citations; 29 full-text articles were evaluated for eligibility after screening. Five case reports were included in this review. The age range of the cases was 27-39 years. Four cases were in their second trimester of pregnancy, and one was in her third. Two cases had undergone previous cesarean sections, and one had an appendectomy and salpingectomy due to an ectopic pregnancy. One case reported a history of alcohol and drug abuse. The most common symptoms were abdominal pain, abdominal distension, oliguria, voiding difficulty, hematuria, fever, and vomiting. The diagnosis of SRUB was primarily made via emergency laparotomy due to the patients' critical conditions. Beyond its diagnostic role, laparotomy was also the treatment method in all cases. Tear repair, antibiotic therapy, and urinary catheterization were all integral parts of the treatment. Four cases resulted in an uneventful pregnancy and a healthy, full-term baby. In one case, a hysterectomy was performed due to a combined uterus and bladder rupture. SRUB often presents with non-specific symptoms, leading to a delayed diagnosis. A high index of suspicion is essential when a pregnant woman exhibits urinary symptoms and severe abdominal pain, especially in those with a history of previous surgery. Early detection and treatment of SRUB are critical for an uneventful recovery.

Keywords: pregnancy; spontaneous bladder rupture; spontaneous rupture of urinary bladder; systematic review; urinary bladder rupture.

Figure 1. Flowchart of the study.