Urinary Bladder Carcinoma as Apparent Cause of Antepartum Haemorrhage in Pregnancy

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Abstract
EDITORIAL COMMENT: We were all taught as undergraduates to ask the woman with postmenopausal bleeding was she sure from which orifice the blood had issued. We have all seen a patient with endometrial carcinoma whose diagnosis was delayed while the urologist investigated her for ‘haematuria’. It is also true that urologists tell of the patient with carcinoma of the bladder whose diagnosis was delayed while the gynaecologist investigated her for postmenopausal bleeding presumed to arise from within the uterus. We know of no data that settles the question of whether urologist or gynaecologist is the greater sinner ‐ the message is to check the second system when the first tests negative. This paper was accepted for publication not only for its rare interest but to remind readers that urinary and genital tract bleeding can be confused in obstetric as well as in gynaecological practice. This case reminded the editor of a 41‐year‐old para 8, referred at 38 weeks' gestation as a nonbookedpatient to the Royal Women's Hospital, Melbourne, with a history of recurrent bleeding considered to be due to placenta praevia, for which she had been hospitalized for many weeks. This patient was cachectic and dying from a Stage 4 carcinoma of the cervix; review of the records revealed that on April 26, 1963 she was delivered of a surviving infant by classical Caesarean section performed because the growth massively involved the lower uterine segment and bladder. She was then treated unsuccessfully with pelvic irradiation and died from uraemia and sepsis 4 months after delivery. Summary A 34‐year‐old multipara presented with painless profuse genital bleeding during the third trimester of pregnancy in a state of haemorrhagic shock. Haematuria because of urinary bladder carcinoma was found to be the cause of bleeding. Cystoscopy was useful for accurate diagnosis as well as for achieving haemostasis. This case emphasizes the possibility and importance of haematuria when dealing wtih a patient with antepartum haemorrhage.

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