Effect of Bladder Dissection Timing During Cesarean Hysterectomy for Morbidly Adherent Placenta on Maternal Outcomes | ||||
| Zagazig University Medical Journal | ||||
| Article 23, Volume 31, Issue 6, June 2025, Page 2446-2456 PDF (1.18 MB) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/zumj.2025.380092.3931 | ||||
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| Authors | ||||
Azza Abd Elmageid Abd Elhameid1; Mohamed Abdel-moniem Ibrahem2; Ali Abdullah Mohammed Alfiqi Alshireef  3; Ahmed Mohamed Abd-Alkader4
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| 1Professor of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig university, Egypt | ||||
| 2Assistant Professor of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig university, Egypt | ||||
| 32Obstetrics and Gynecology Department, Faculty of Medicine, El-Mergib university, Libya | ||||
| 4Lecturer of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig university, Egypt | ||||
| Abstract | ||||
| Background: Placenta accreta spectrum is the commonest cause of cesarean hysterectomy. Cesarean hysterectomy is considered the gold standard for the treatment, leaving placenta in situ, to control postpartum hemorrhage and for women want to preserve fertility, many conservative approaches are tried. This study aimed to assess the role of bladder dissection timing during cesarean hysterectomy by evaluating what is better bladder dissection before or after uterine opening. Methods: This randomized controlled clinical trial was conducted on patients with placenta accrete spectrum diagnosed by ultrasound criteria and Doppler or by MRI who attended outpatient clinics and maternity Hospital of Zagazig University Hospital. 40 Patients were assigned to either Group A (bladder dissection before uterine incision) or Group B (after uterine closure and before uterine artery clamping) who attended to outpatient clinics and maternity Hospital of Zagazig University Hospital. Results: there was Significantly lower estimated blood loss (1722.5±214.3mlvs. 2555±585.3ml), shorter operative time (123.5±13.6 vs. 153.4±14 min) and reduced Transfusion requirements in group A compared to group B. Also the urinary tract injury rate was lower in Group A than in group B (5% vs. 15%), this was not statistically significant (p >0.05). No significant differences were observed in ICU admissions, neonatal outcomes, or maternal survival (all p>0.05). Baseline characteristics were comparable between groups. Conclusion: Surgical management of morbidly adherent placenta by cesarean hysterectomy suggested that bladder dissection before fetal delivery is much better in terms of decreasing blood loss, shorter operation time, need for blood transfusion and reduce risk of bladder injuries. | ||||
| Keywords | ||||
| Placenta accreta spectrum; Cesarean hysterectomy; Morbidly adherent placenta | ||||
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