Fistulas found during pregnancy likely existed previously, but in rare cases, they form during pregnancy. In developed countries, vesicovaginal or cervicovaginal istula following a McDonald cerclage has been reported (Massengill, 2012; Zanconato, 2015). These fistulas may also form with prolonged obstructed labor that is more often seen in resource-poor countries (Cowgill, 2015). In these cases, the genital tract is compressed between the fetal head and bony pelvis. Brief pressure is not signiicant, but prolonged pressure leads to tissue necrosis with subsequent fistula formation (Wall, 2012). Vesicouterine istulas can develop after prior vaginal or cesarean delivery (DiMarco, 2006; Harfouche, 2014; Manjunatha, 2012). Rarely, vesicocervical istula can follow cesarean delivery or may form if the anterior cervical lip is compressed against the symphysis pubis (Dudderidge, 2005). Finally, an ileouterine istula from a degenerating posterior wall fibroid tumor has been described (Shehata, 2016).
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