Is the Formation of a Bladder Flap at Cesarean Necessary? A Randomized Trial

Hohlagschwandtner, Maria; Ruecklinger, E.; Husslein, Peter; Joura, Elmar A.

doi:10.1097/00006250-200112000-00017

Cited by 26 publications

(24 citation statements)

References 9 publications

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“…Another limitation of such studies is the difficulty in obtaining the primary reports on previous cesarean deliveries. The different surgical techniques used in previous cesarean operations had a significant effect on adhesion formation and the level of intraoperative bleeding, with the leading diversities in surgical techniques being related to peritonization, rectus muscle closure, formation of a bladder flap, closure of subcutaneous tissue, and the use of superficial wound drains (15)(16)(17)(18). In order to overcome all of these technical diversities, only pregnant women whose previous cesarean deliveries had been carried out at our institution were included in the study, where a standard surgical technique for cesarean sections has been in place for 6 years.…”

Section: Discussionmentioning

confidence: 99%

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

Gültekin¹,

Gültekin²,

Yılmaz³

et al. 2017

Turk J Med Sci

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Background/aim: This study aimed to evaluate the impact of body fat distribution measured by body mass index (BMI), waist circumference (WC) and Pfannenstiel incision site tissue thickness, and elastosonography on bleeding and operation time during cesarean delivery. Materials and methods:A prospective study was made of 52 healthy, term pregnant women with prior cesarean deliveries. The impact of BMI, WC, incision site thickness, and elastosonography on preoperative and postoperative differences in hemoglobin (Hb) and hematocrit (Htc) levels and operation times was evaluated.Results: A moderate negative relationship was found between Htc levels and WC. Htc levels were found to decrease by 0.148 units for each 1-cm increase in WC. Skin-to-fascia time was found to increase by 0.697 s with each 1-unit increase in BMI, whereas fascia-touterus time was found to increase by 1.117 s with each 1-cm increase in Pfannenstiel site tissue thickness. None of the elastosonographies or differences in Hb levels were found to be significant for any parameter. Conclusion:Each of the evaluated parameters was found to have an impact on different factors: WC on Htc levels, BMI on skin-tofascia time, and Pfannenstiel tissue thickness on fascia-to-uterus time.

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Section: Discussionmentioning

confidence: 99%

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

Gültekin¹,

Gültekin²,

Yılmaz³

et al. 2017

Turk J Med Sci

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show abstract

“…12 Only one study evaluated omission of the bladder flap as the only modification. This single randomized trial compared omission of the bladder flap in 53 patients to the standard technique of caesarean section in 49 patients, results showed significant short term benefits of omitting the bladder flap including a less operating time, blood loss, postoperative pain and microhematuria.…”

Section: 12mentioning

confidence: 99%

“…[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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“…Development of a bladder flap before the uterine incision is made has been shown to be unnecessary (Hohlagschwandtner et al, 2001). It is simpler and faster to just transversely score the lower uterine segment at the upper edge of the bladder flap (in other words, at the upper edge of the visceral reflection of the bladder peritoneum ---however, see the warning about obstructed labors in the next section).…”

Section: The Uterine Incision: Don't Cut the Baby!mentioning

confidence: 99%

Cesarean Delivery: Surgical Techniques - The Fifteen Minute Cesarean Section

Dyson¹

2012

Cesarean Delivery

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Is the Formation of a Bladder Flap at Cesarean Necessary? A Randomized Trial

Cited by 26 publications

References 9 publications

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

Impact of body mass index, waist circumference and Pfannenstiel sitetissue thickness, and elastosonography on operative parameters

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

Cesarean Delivery: Surgical Techniques - The Fifteen Minute Cesarean Section

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