Risk factors for bladder injury during placenta accreta spectrum surgery

Friedrich, Lior; Mor, Nizan; Weissmann-Brenner, Alina; Kassif, Eran; Friedrich, Shakad Noah; Weissbach, Tal; Castel, Elias; Meyer, Raanan

doi:10.1002/ijgo.14567

Cited by 8 publications

(4 citation statements)

References 19 publications

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“…The multidisciplinary team at Dr. Moewardi Hospital was successful in preventing urinary bladder and ureter injury, with only 9 bladder and ureter injury cases (5.4%), which is lower than the previous study by Mohammed et al (2018) with 31%, [49] Mitric et al (2019) with 12.7%, [26] and Friedrich et al (2022) with 9.3% [50] . The maternal ICU referral in Dr. Moewardi Hospital was also comparatively low, with only 11 out of 167 (6.6%) admissions, compared to previous studies by Mohammed et al (2018) with 42% admissions, [49] Kandil et al (2019) with 22.5% admissions, [18] and Ornaghi et al (2021) with 24% admissions [51] .…”

Section: Discussionmentioning

confidence: 58%

Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder

Yuliantara,

Bachnas,

Anggraini

et al. 2023

Placentum J. Ilmiah Kes. Apl.

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Background: Placenta accreta spectrum (PAS) is considered one of the most harmful pregnancy conditions, as it is strongly linked with maternal morbidity and mortality. An accurate and early prenatal diagnosis of PAS allows time for a multidisciplinary team to plan the best course of action for delivery management. The aim of this study is to describe placenta accreta spectrum management and outcomes with early detection and a multidisciplinary team approach.Method: A retrospective cohort study was conducted on 167 cases of placenta accreta from 2016 to 2021. Medical records were then reviewed, and data were collected for delivery management and maternal outcome, including estimated amounts of bleeding, urinary tract injury, delivery time, ICU referral, and maternal death.Result: Delivery management (hysterectomy and conservative management) and maternal bleeding were significantly associated with MAP score (p < 0.05), while urinary tract injury, delivery time, ICU admission, and maternal death were not significantly associated (p > 0.05). 55.1% of patients underwent hysterectomy, and the rest 44.9% underwent conservative surgery. Massive bleeding of more than 2500 mL happened in 54.5% of patients, and the rest 45.5% managed to bleed less than 45.5%. Preterm deliveries accounted for 29.9% of all deliveries, with the remaining 70.1% being term. 5.4% of patients experienced urinary tract injuries. 6.6% of patients were referred to the intensive care unit. The maternal mortality rate is 4.8%.Conclusion: Early detection of the placenta accreta spectrum, as well as good collaboration among members of a multidisciplinary team from various medical fields, are required to ensure the mother and baby's safety and survival.

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Section: Discussionmentioning

confidence: 58%

Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder

Yuliantara,

Bachnas,

Anggraini

et al. 2023

Placentum J. Ilmiah Kes. Apl.

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“…A single‐center cohort study of 292 patients in the USA reported an incidence of 19.9% urologic morbidity, with a higher incidence in those patients diagnosed with placenta percreta 29 . Similarly, a single‐center cohort study of 312 patients in Germany found a bladder‐injury incidence of 9.3% with a higher risk in patients with ultrasound imaging suggesting a placenta percreta 30 . In view of recent evidence, indicating that normal villous tissue does not cross the uterine serosa 3,31 , these cases are likely to be the consequence of surgical dissection of a dehiscent LUS covered only by a thin layer of scar myometrium and single‐cell layer of serosa epithelium 32 .…”

Section: Discussionmentioning

confidence: 99%

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case–control study

Hussein,

Thabet,

Elbarmelgy

et al. 2024

Ultrasound in Obstet & Gyne

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ObjectivesIntraoperative hemorraghe and peripartum hysterectomy are the main complications in patients presenting with a low‐lying or placenta previa undergoing repeat cesarean delivery. Patients with a high probability of placenta accreta spectrum (PAS) at birth also have a higher risk of intraoperative urologic injuries and the aim of this study was to evaluate the ultrasound signs and intraoperative features associated with these injuries.MethodsThis was a retrospective case–control study of consecutive singleton pregnancies included in a prospective cohort of patients with a history of at least one prior cesarean delivery (CD) and were diagnosed prenatally with an anterior low‐lying or placenta previa at 32‐36 weeks. All patients underwent investigational preoperative transabdominal and transvaginal ultrasound examinations within 48h prior to delivery. Ultrasound anomalies of uterine contour and utero‐placental vascularity and gross anomalies of the lower uterine segment (LUS) and surrounding pelvic tissue at delivery were recorded using a standardised protocol including the evaluation of the size of anomalies of uterine contour. The diagnosis of PAS was established when one or more placental lobule(s) could not be digitally separated from the uterine wall at delivery or during the gross examination of the hysterectomy or partial myometrial resection specimens, confirmed by histopathology. Data were compared between cases complicated by intraoperative urologic injuries and three controls from the same cohort matched by parity and the number of prior cesarean deliveries using conditional logistic regression.ResultsThere were 16 (9.4%) patients with an intraoperative bladder injury out of a cohort of 170 patients managed by the same multidisciplinary team during the study period. There were no patients diagnosed with ureteric or bladder trigone damage. Fourteen patients (87.5%) with a bladder injury had histopathologic evidence of PAS at birth including 11 (68.8%) cases described on microscopic examination as placenta increta and three as placenta creta. There was a significant (p= 0.03) difference between cases and controls in the distribution of the intraoperative LUS vascularity with the higher the number of enlarged vessels the higher the odds ratio (OR) of bladder injury. The multivariable regression analysis revealed that both gestational age and LUS remodelling on transabdominal ultrasound were associated with a bladder injury. A longer gestational age was associated with a lower risk of an injury. A higher LUS remodelling grade on TAS was associated with an increased risk of bladder injury. Patients with a grade of 3 (involving > 50% of the LUS) had odds of a bladder injury that were 9 times higher than for patients with a grade of 1 (involving < 30% of the LUS).ConclusionsPreoperative ultrasound examination is useful in the evaluation of the risk of the intraoperative bladder injury in patients with a history of prior CD presenting with a low‐lying or placenta previa. The larger the remodelling of the LUS on transabdominal ultrasound the higher the risk of adverse urologic events.This article is protected by copyright. All rights reserved.

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“…The contact between the injured uterus and bladder, results in their adherence during healing process 28 . This abnormal adherence is associated with an increased risk of bladder injury even outside the context of PAS which usually occurs during peritoneal entry or while creating the bladder ap [29][30][31] . This nding was also observed in a large retrospective cohort of PAS cases in Italy 32 .…”

Section: Discussionmentioning

confidence: 99%

Vesicouterine adherence is independent of the degree of villi implantation: A retrospective case-control study

Valentina,

Ariani,

Priangga

et al. 2024

Preprint

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Background: The presence of differences between the clinical and histological classification of PAS hinders an accurate depiction of the extent of the maternal condition. None of the existing histological classification criteria are based on and correlate with surgical difficulty, morbidity risk, or maternal outcome. Methods: We conducted a case-control study of data of all PAS cases between January 2017 and December 2021 at Dr. Soetomo General Hospital, Surabaya, Indonesia. Uterine dehiscence and any cases with incomplete data were excluded from the study. After surgery, the area of abnormal adherence was marked using small pins for histological analysis. The histopathology specimens were immersed in using Hematoxylin Eosin (HE). PAS cases were divided into three groups depending on the depth of villi: accreta, increta and percreta. Primary outcome was the vesicouterine adherence. Secondary outcomes were intraoperative topography, and surgical outcome. Results: Three hundred sixty-three cases were included for analyses. Our cohort comprised of 99 accreta cases, 246 increta cases and 18 percreta cases. Estimated blood loss was significantly higher in the high-grade PAS (increta and percreta) groups than in the low-grade PAS (accreta) group (2851.0 + 2437.7 mL vs 1970.8 + 1315.8 mL; p < 0.001). Sixty-five (17.9%) cases of vesicouterine adherence were observed. This was associated with higher odds of caesarean hysterectomy (adjusted odds ratio [Adj OR] 30.77 (95% CI 12.52–75.62; p < 0.001) and bladder injury (Adj OR 7.19; 95% CI 1.94–26.64; p = 0.003) but not estimated blood loss (> 2500 mL) (Adj OR 1.06; 95% CI 0.52–2.16; p = 0.87). Cases with bladder injury had a higher estimated blood loss (p = 0.012) and concomitant caesarean hysterectomy (p < 0.001) compared to those without bladder injury. The depth of villi implantation was associated with higher blood loss (> 2500 mL) (p = 0.046) but not bladder injury (p = 0.442) and vesicouterine adherence (p = 0.503). Conclusions: Vesicouterine adherence is not associated with the depth of villi implantation, but rather with the presence of fibrosis between the bladder and uterus. These adhesions also correlated to iatrogenic bladder injuries.

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Risk factors for bladder injury during placenta accreta spectrum surgery

Cited by 8 publications

References 19 publications

Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder

Early Detection and Good Team Collaboration for Preventing Maternal Death Caused by Placenta Accreta Spectrum Disorder

Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case–control study

Vesicouterine adherence is independent of the degree of villi implantation: A retrospective case-control study

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