Iatrogenic bladder injuries during caesarean delivery: A case control study

Abstract

This study determined the rate, risk factors, management and outcome of bladder injury during caesarean section and suggests ways to improve the quality of care and reduce maternal morbidity and mortality. During the study period, there were 76 bladder injuries in 56,799 caesarean deliveries for an overall incidence of 0.13%. Women with a bladder injury were more likely to have had a prior caesarean delivery, as compared with the control group (72.4% vs 34.2%; p < 0.001). Cases were also more likely than controls to have had prior pelvic surgery. The presence of adhesions during the procedure was greater in the bladder injury group than the controls. In conclusion, our study suggests that a previous caesarean delivery is the most common risk factor for bladder injury during caesarean delivery. Moreover, the presence of labour, station of the presenting fetal part deeper than or equal to +1, and a large baby were independent risks for a bladder injury during caesarean delivery. Women requesting primary caesarean deliveries should be counselled about the potential for significant surgical complications in repeat caesarean deliveries when discussing the indications for a primary elective caesarean delivery.

Intraoperative damage to the urinary bladder during cesarean section — literature review

“…In analyzing how to perform caesarean section and its impact on the traumatism of the urinary bladder, it should be stated that the way to open the abdominal wall (modification of Pfannenstiel method, or longitudinal midline cut) does not change the probability of damage [8]. About 28.0-46.6% of damage to the bladder occurs during the opening of the peritoneum [7][8][9].…”

“…About 28.0-46.6% of damage to the bladder occurs during the opening of the peritoneum [7][8][9]. In the studies of some authors, bladder injuries, which occur during the opening of the peritoneum, dominate during the first cesarean section (46.6%), while the subsequent cesarean section predisposes to injuries in the opening of vesico-uterine pouch (32.0--60.0%) [2,[7][8][9]. Opening the peritoneum using the "sharp" method (Pfannenstiel method), compared to the opening with the "blunt" method (Joel-Cohen and Misgav-Ladach methods) seems to be the safer method, especially if it is the subsequent cesarean section [7].…”

“…Hysterotomy without forming bladder flap, as in the -Misgav-Ladach method and its modifications, seems to be safe mostly at first cesarean section. Special attention should be paid to this stage of the surgery, because about 23.8% of damage in case of women who give birth for first time and up to 60.0% of injuries in case of the next cesarean section is made at that moment [2,[7][8][9]. Approximately 14.3% of injuries occur at the time of hysterotomy (in the following caesarean section, this value rises up to 40%) [8].…”

“…The distant consequence of such a technique is the greater chance of adhesions in the lower segment of the uterus, which may lead to difficulties in the subsequent ceasarian section and damage to the bladder [7,8,[13][14][15]. Therefore, what seems reasonable is avoiding suturing of the peritoneum as in the Joel-Cohen and Misgav-Ladach methods.…”

“…Incidence of bladder damage after cesarean section ranges from 0.08 to 0.94% [2][3][4][5][6][7][8]. The data on injuries of the urinary bladder during caesarean section, however, are divergent because the available manuscripts use inconsistent definitions of damage and do not specify the severity of damage.…”