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

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.