Unraveling the complexities: stress urinary incontinence, pubic diastasis with bladder herniation and pelvic organ prolapse following obstructed labor of macrosomic stillborn

Pelvic floor dysfunctions such as stress urinary incontinence (SUI), pelvic organ prolapse (POP), and pubic diastasis are known complications of obstructed labor, particularly in cases involving macrosomic infants. Macrosomia, defined as birthweight >4000 g, significantly increases maternal pelvic floor stress, which can result in long-term morbidity. While individual conditions such as SUI and POP are well documented, the coexistence of multiple pelvic floor injuries, including bladder herniation through pubic diastasis, is exceedingly rare. We report a unique case of a female in her early 40s with a history of obstructed vaginal delivery of a 6.5 kg stillborn infant 13 years ago. Despite a previously uneventful antenatal course, the prolonged labor led to significant trauma. Over the years, she developed worsening SUI, a right-sided groin swelling, and recurrent POP, despite undergoing vaginal hysterectomy and cystocele repair. Imaging revealed a 4 cm pubic diastasis, a right sacroiliac joint fracture, and bladder herniation into the labia majora. A multidisciplinary surgical approach was undertaken, including abdominal sacrocolpopexy, Burch colposuspension, and fixation of pubic diastasis and the sacroiliac joint. Postoperative recovery was successful, with significant improvement in symptoms and quality of life. This case illustrates the devastating pelvic floor consequences of obstructed labor, particularly in the context of macrosomia. It emphasizes the importance of early recognition of bony and soft tissue injuries, appropriate imaging, and a tailored, multidisciplinary surgical approach. It also highlights the need for proactive antenatal care and high clinical suspicion in post-labor patients presenting with persistent urinary/pelvic symptoms.