Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study

Alanwar, Ahmed; Al-Sayed, Helmy M; Ibrahim, Ahmed M. S.; Elkotb, A M; Abdelshafy, Ahmed; Abdelhadi, Rasha; Abbas, Ahmed M.; Abdelmenam, Hend S; Fares, Tamer; Nossair, Wael S.; Abdallah, Ameer; Sabaa, Haitham; Nawara, Maii

doi:10.1080/14767058.2017.1408069

Cited by 23 publications

(20 citation statements)

References 15 publications

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“…Bladder injury was recorded in 39.5%. Our findings were supported by many studies which reported that complications after cesarean hysterectomy were higher with bladder and ureteric injuries are the most common injuries reported [26, 33–36].…”

Section: Discussionsupporting

confidence: 89%

Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study

Gelany

Mosbeh

Ibrahim

et al. 2019

BMC Pregnancy Childbirth

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Background Placenta accreta spectrum (PAS) disorders have become a significant life-threatening issue due to its increased incidence, morbidity and mortality. Several studies have tried to identify the risk factors for PAS disorders. The ideal management for PAS disorders is a matter of debate. The study objectives were to evaluate the incidence and risk factors of PAS disorders and to compare different management strategies at a tertiary referral hospital, Minia, Egypt. Methods This prospective study included 102 women diagnosed with PAS disorders admitted to Minia Maternity university hospital, Egypt between January 2017 to August 2018. These cases were categorized into three groups according to the used approach for management: Group (A) , ( n = 38) underwent cesarean hysterectomy, group (B) , ( n = 48) underwent cesarean section (CS) with cervical inversion and ligation of both uterine arteries and group (C) , ( n = 16): the placenta was left in place. Results The incidence of PAS disorders during the study period was 9 / 1000 maternities (0.91%). The mean age of cases was 32.4 ± 4.2 years, 60% of them had a parity ≥3 and 82% of them had ≥2 previous CSs. Also, 1/3 of them had previous history of placenta previa. Estimated blood loss (EBL) and blood transfusion in group A were significantly higher than other groups. Group (C) had higher mean hospital stay duration. Group A was associated with significantly higher complication rate. Conclusions The incidence of PAS disorders was 0.91%. Maternal age > 32 years, previous C.S. (≥ 2), multiparity (≥ 3) and previous history of placenta previa were risk factors. The management of PAS disorders should be individualized. Women with PAS disorders who completed their family should be offered cesarean hysterectomy. Using the cervix as a tamponade combined with bilateral uterine artery ligation appears to be a safe alternative to hysterectomy in patients with focal placenta accreta and low parity desiring future fertility. Patients with diffuse placenta accreta keen to preserve the uterus could be offered the option of leaving the placenta aiming at conservative management after proper counseling. Trial registration Registered 28th October 2015, ClinicalTrials.gov NCT02590484 .

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Section: Discussionsupporting

confidence: 89%

Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study

Gelany

Mosbeh

Ibrahim

et al. 2019

BMC Pregnancy Childbirth

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“…Also authors reported one case (0.2%) of colonic injury and 2 cases (0.4%) of vascular injury that is in agreement with Rosenberg et al 2011 study who reported that surgical complications such as cystotomy, ureteric and vascular injury are more with PA. 11 Additionally, these results were coincided with Alanwar et al, 2018 who reported the incidence of urinary tract injuries during CS with morbid adherence placenta was 21.7% (Bladder 11.7%, Ureter 4.7%, and bladder with ureter 5.3%). 12 In rare cases, the placenta could invade beyond the abdominal viscera and reach the anterior abdominal wall. 13 In the present study, the placenta left in situ in 3 cases of PA. All cases needed blood transfusions (up to 10 units) and one of them ended by post-operative uterine sepsis and ended by hysterectomy.…”

Section: Discussionmentioning

confidence: 99%

Maternal and neonatal outcomes of placenta previa and accreta at Assiut women’s health hospital, Egypt

Zakherah

Abdel-Aziz

Othman

et al. 2018

Int J Reprod Contracept Obstet Gynecol

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Background: The aim of the current study was to estimate the incidence of placenta previa (PP) and accreta (PA) in the period from January 2015 to December 2016 at Women’s Health Hospital, Assiut University, Egypt and to evaluate the maternal and neonatal outcomes.Methods: The study included all cases of PP with or without suspicion of accreta who were diagnosed preoperatively by ultrasound at Women’s Health Hospital, Assiut University. Maternal and neonatal outcomes were evaluated. All intraoperative and postoperative data were reported. The obtained data was analyzed by means of SPSS software (version 22.0) and p<0.05 was taken as the significant level.Results: Total number of deliveries was 29027 cases. The number of cases of PP was 494 cases making an incidence of 1.7%, among them 95 cases were confirmed during surgery to be accreta (0.33%). Uterine artery ligation was carried out 300 cases (60.7%) of cases while cesarean hysterectomy was performed in 56 cases (11.3%). Bladder injury occurred in 58 cases (11.7%), ureteric injury occurred in 6 cases (1.2%), colon injury occurred in 1case (0.2%) and vascular injury occurred in 2 cases (0.4%). Maternal mortality was 4 cases (0.8%). The mean gestational age was 34.73 ± 2.8 weeks. Also, over the two years there were 148 neonatal cases (29.9%) needed assisted ventilation in the form of ambu bag or endotracheal intubation gestation. NICU admission needed in 109 neonatal cases (22.06%) and neonatal mortality reported in 18 neonates (3.6%).Conclusions: The incidence of both PP and PA is very high in our locality due to increase CS rate.

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“…In another study [4] reported that, patients with repeated Cesarean sections were associated with bladder injury in 0.81% of cases while bladder injury was reported only in 0.27% of patients who had Cesarean section for first time. Urinary bladder injury complicates about 11.7% of cesarean sections in women with placenta accreta spectrum (PAS) [5]. Urinary bladder adhesions are the main risk factor for urinary bladder injury.…”

Section: Introductionmentioning

confidence: 99%

Could Bladder Inflation Prior to Cesarean Section Prevent Urinary Tract Injury in High Risk Group? A Randomized Controlled Trial

Ali¹,

Ahmed²,

Khodry³

et al. 2019

OJOG

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Background: Accidental urinary tract particularly bladder injury during cesarean delivery has a significant maternal morbidity, as it may lead to extended operative time, infection of urinary tract and sometimes development of urinary tract fistulae. Objective: To find out the efficacy of urinary bladder inflation immediately prior to cesarean section (CS) procedure in minimizing incidence of accidently urinary tract injury in high risk patients.

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Urinary tract injuries during cesarean section in patients with morbid placental adherence: retrospective cohort study

Abstract: The morbid adherent placenta is still a challenge, which faces us as obstetricians, due to high morbidity and mortality. A multidisciplinary team is mandatory to avoid complications.

Cited by 23 publications

References 15 publications

Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study

Placenta Accreta Spectrum (PAS) disorders: incidence, risk factors and outcomes of different management strategies in a tertiary referral hospital in Minia, Egypt: a prospective study

Maternal and neonatal outcomes of placenta previa and accreta at Assiut women’s health hospital, Egypt

Could Bladder Inflation Prior to Cesarean Section Prevent Urinary Tract Injury in High Risk Group? A Randomized Controlled Trial

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