Effect of avoiding bladder flap formation in caesarean section on repeat caesarean delivery

Malvasi, Antonio; Tinelli, Andrea; Guido, Marcello; Cavallotti, Carlo; Dell'Edera, Domenico; Zizza, Antonella; Renzo, Gian Carlo Di; Stark, Michael; Bettocchi, Stefano

doi:10.1016/j.ejogrb.2011.09.001

Cited by 31 publications

(12 citation statements)

References 19 publications

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“…[8][9][10] recently recognized that closure of the bladder flap is not necessary and has been abandoned. [7][8][9][11][12][13][14][15][16] In emergency cesarean sections, rapid delivery should be achieved; the bladder dissection is commonly cancelled. 11,13 A simple method of cesarean section (Pelosi-type) including omission of the bladder dissection Department Obstetrics and Gynecology, Alexandria University, Shatby Maternity University Hospital, Egypt is one the modifications that showed to be safe and cost effective.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of bladder dissection in cesarean section: a randomized controlled trial

Elsersy

2016

Int J Reprod Contracept Obstet Gynecol

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Background: There are various different methods of performing a caesarean section. With the increasing rate of repeat cesarean sections, it is necessary to recognize evidence based techniques to improve outcomes and minimize complications. Dissection of a bladder flap was an integral step in standard cesarean section. Cancelation of the bladder dissection is one the modifications that showed to be safe and cost effective. The aim of this study is to perform a randomized controlled clinical trial to evaluate the effects of cancelling the bladder dissection. Methods: 1674 patients were enrolled in the study from May 2013 until October 2015. The patients were assigned for non-emergent cesarean section above 32weeks. They were randomly allocated in the 2 groups.Group1:838 patients to whom uterine incision made without incision or dissection of the bladder peritoneum. Group 2: 836 patients to whom incision and dissection of a bladder peritoneum done prior to uterine incision. Results: Significant reduction of the total operating time, skin to delivery time, micro hematuria, dysuria, urinary retention, blood loss in group 1. The were insignificant difference between the groups as regards hospital days, febrile morbidity, wound infection rate, admission to neonatal intensive care unit and readmission rate. Conclusions: Non dissection of the bladder peritoneum achieved short-term advantages as regards reduction of operating time, incision-delivery duration and decreased blood loss; long-term effects still to be studied.

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Section: Introductionmentioning

confidence: 99%

Usefulness of bladder dissection in cesarean section: a randomized controlled trial

Elsersy

2016

Int J Reprod Contracept Obstet Gynecol

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“…The creation of a bladder flap and its closure, was thought to protect the peritoneal cavity from spreading infection while enabling surgeons access to the lower uterine segment, minimizing injury to the bladder. Although a bladder flap is a standard part of cesarean births, there is not enough evidence showing its effectiveness in current practice [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Most recently, Tuuli et al [11] reported that by omitting the bladder flap there was no increase in complications creating shorter incision to delivery times. Malvasi et al [8] investigated the relationship between bladder flap created primary cesarean births and adhesion formation in the subsequent cesarean births. The formation of a bladder flap during the first cesarean delivery was associated with a significantly higher rate of adhesion between the bladder and the uterus in subsequent cesarean deliveries [8].…”

Section: Discussionmentioning

confidence: 99%

“…Malvasi et al [8] investigated the relationship between bladder flap created primary cesarean births and adhesion formation in the subsequent cesarean births. The formation of a bladder flap during the first cesarean delivery was associated with a significantly higher rate of adhesion between the bladder and the uterus in subsequent cesarean deliveries [8]. Further, a recent meta-analysis, including 3 studies, found that omission of a bladder flap during cesarean birth was associated with shorter incision to-delivery time, while the total operating time remained unchanged [12].…”

Section: Discussionmentioning

confidence: 99%

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Omission of a Bladder Flap during Cesarean Birth in Primiparous Women

Çetin

Mathyk

Barut

et al. 2017

Gynecol Obstet Invest

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Aims: Creation of a bladder flap has traditionally been an integral surgical step of Cesarean birth, and the practicality of such a procedure to create a bladder flap is still highly debated. Methods: A total of 208 patients undergoing a primary cesarean birth were randomized. Group 1 (bladder flap) had 101 patients and group 2 (omission of a bladder flap) had 100 patients. The primary outcome was the total operating time and secondary outcomes were postoperative urinary symptoms, bladder injury, postoperative urinary retention, and postoperative residual urine volume. Results: No significant differences were found among groups in terms of mean total operating time and mean skin incision-to-delivery time. No bladder injury occurred in either group. Postoperative urine retention observed in the bladder flap group was 2%. The postoperative residual urine volume was significantly more in the bladder flap group compared to the non-bladder flap group (24.5 ± 2.8 vs. 16.2 ± 1.4 mL). The number of patients with dysuria was significantly higher in the bladder flap group (42 vs. 13%). Conclusions: The creation of a bladder flap during cesarean birth does not have an effect on intraoperative results and operation time, but it is associated with short-term urinary complaints, such as postoperative urinary retention and dysuria.

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“…Obstetrics agreed with woman to delivery by a scheduled repeated cesarean section, who was at 38 weeks by Stark method [4], by a Joel-Cohen laparotomy, performed by a superficial transverse cut in the cutis, about 3 centimetres below an imaginary line drawing between the iliac anterior-superior spines, cutting only through cutis. A small transverse opening was made in the fascia with the tip of a scalpel, and then, the fascia was opened transversely underneath the fat tissue and blood vessels by pushing the slightly open tip of a pair of straight scissor, first in one direction, and then in the other.…”

Section: Case Reportmentioning

confidence: 99%

Post-Cesarean Section Hemorrage Treated by a Collagen Patch Coated with the Human Coagulation Factors

Tinelli¹

2011

J Clinic Case Reports

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Uterine hemorrhage is a common problem at the time and after caesarean section especially in a repeat caesarean section, where the surgical techniques used widely differ. An inadequate hemostasis of the uterine incision and the vesical-uterine vessels during CS, in closed and open visceral peritoneum, could lead to early hemorrhagic compliances, to control by further surgery.We present the case of a 31 year old woman undergoing a scheduled repeat emergency caesarean section. She had progressive bleeding from the incision site during the first post-operative days, since in third day she developed a hemorrhagic shock for a hemoperitoneum. Patient was re-operated and bleeding at uterine site incision was not controlled by traditional management including intravenous oxytocin and ergometrine, intramyometrial ergometrin and local hemostatic sutures, but was successfully controlled by equine collagen patch coated with human coagulation factors. Her post operative period was uneventful and she and her baby were discharged in good condition on day 5. Both of them were doing well on a follow up visit after 1 month.

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Effect of avoiding bladder flap formation in caesarean section on repeat caesarean delivery

Cited by 31 publications

References 19 publications

Usefulness of bladder dissection in cesarean section: a randomized controlled trial

Usefulness of bladder dissection in cesarean section: a randomized controlled trial

Omission of a Bladder Flap during Cesarean Birth in Primiparous Women

Post-Cesarean Section Hemorrage Treated by a Collagen Patch Coated with the Human Coagulation Factors

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