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

Abstract

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.

The Effect of Omission of the Bladder Flap Formation at Lower Segment Cesarean Delivery: A Randomized Controlled Trial

“…There is significant decrease in Hb level range post-operative in the bladder flap group (1.1 ± 0.6 range 0.6 -2.1 gm/dl). This study had strikingly similar results to our study especially in terms of skin to delivery and total operation time [11].…”

“…The results match the Pelosi technique which introduced non bladder flap in the first place [12] and previous researches on the subject [9] [11]. We find that the covenantal dissection of the bladder flap routinely done in traditional CS is not necessary and can be safely omitted unless it's indicated in highly adhesive fields as in repeat CS.…”