Vesicouterine Fistula During Pregnancy: Case Report and Systematic Literature Review on Clinical Characteristics, Management, and Outcomes

Background: This study presents a case of vesicouterine fistula (VUF) diagnosed during pregnancy and offers a systematic review to identify clinical guidance for managing this rare but serious obstetric complication. Methods: We performed a systematic review of international databases from inception to May 2025, including studies on VUF diagnosed during pregnancy regardless of obstetric outcome. Studies on other genitourinary fistulas, non-pregnant women, or extrauterine pregnancies were excluded. No study design restrictions were applied. Results: Twenty-two VUF cases with primary intrauterine implantation during pregnancy were identified, including one from our center. All had prior cesarean delivery (100%). Fourteen fetuses (63.6%) died, one pregnancy (4.5%) was terminated surgically, and seven (31.8%) resulted in live births. Conservative treatment included antibiotics and bladder catheterization. Among viable cases: two full-term (9.1%), one preterm (32-34 weeks, 4.5%), and four preterm (< 32 weeks, 18.2%). Conclusion: Available evidence on VUF during pregnancy consists solely of case reports. Gestational age and fetal viability are key factors in guiding treatment (expectant management versus intervention). This review underscores the risk of complications and highlights the need for careful evaluation in women with risk factors, especially those with urinary or menstrual symptoms following cesarean delivery.