Lateral versus central approach in dissecting urinary bladder during cesarean section in placenta accreta spectrum: case control study

Badr, Minia; Ahmed, Heba Hassan; El Gelany, Saad; Kamal, Mostafa

doi:10.21608/mjmr.2024.259907.1636

Lateral versus central approach in dissecting urinary bladder during cesarean section in placenta accreta spectrum: case control study

Document Type : Original Article

Authors

¹ Obstetric and Gynecology department, Faculty of Medicine, Minia University

² Obstetrics and gynecology department, faculty of medicine, minia university, minia, Egypt

³ Obstetrics and Gynecology, Faculty of Medicine – Minia University, Egypt.

⁴ obstetrics and gynecology, faculty of medicine, minia university

10.21608/mjmr.2024.259907.1636

Abstract

Injury of the urinary bladder is a prevalent complication associated with cesarean sections. Multiple cesarean sections, placenta previa (PP), and any form of Placenta accreta spectrum (PAS) disorders are recognized as a significant risk factors for urinary tract injuries after cesarean birth.

Aim: To compare the urological outcomes of lateral and classical central urinary bladder dissection, in placenta previa and PAS cases.

Methods: A case controlled study included patients suspected to be PAS disorders based upon ultrasound findings (2D and color Doppler ultrasound) was conducted.

All recruited patients were subjected to caesarian delivery with 2 modalities of bladder dissection; central and lateral approaches.

Results: A total of 111 pregnant women suspected with PAS disorders were recruited; 85 females had central and 26 had lateral bladder dissection. Eighty-seven of our patients were placenta previa and 24 were PAS cases; 71-cases with PP were subjected to central bladder dissection and 16 had lateral approach while the placenta accrete cases; 14 had central approach and 10 had the lateral approach of bladder dissection. The urinary system injuries among the PP group was 17% among central group in comparison to 0% among the lateral group with a significant difference between them (P=0.021*). While the urinary system injuries among the placenta accrete group was 21.4% among the central group and 20% among the lateral approach group with no significance between them.

Conclusion: Lateral approach of bladder dissection may reduce the incidence of urinary system injuries among PP cases and of lower significance among PAS.

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