Bladder injuries associated with cesarean section.
ABSTRACT Bladder injury during cesarean section is unusual and may occur by failure to empty the bladder preoperatively, inadequate bladder flap reflection or incision into the vagina rather than the lower uterine segment. Three bladder injuries during cesarean section are reported. Although 2 women recovered normally 1 has persistent vesicoureteral reflux. With liberalization of indications for cesarean section bladder injuries may be seen more frequently.
- Australian and New Zealand Journal of Obstetrics and Gynaecology 06/1990; 30(2):184-5. · 1.30 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Objective: Identify the risk factors for bladder injury during cesarean section. Material and methods: A case-control study was conducted at INPerIER with women undergoing cesarean section from 1 January 2001 to 31 December de 2007. The cases were women who had experienced bladder injury during the procedure; two women per case were selected as controls, who underwent cesarean section without bladder injury during the same period. The medical charts were reviewed for analysis and comparison of the demographic and clinical characteristics. Results: Among the 24,057 cesarean sections, 21 bladder injuries were found (incidence 0.087%), of which only 19 were analyzed. Previous cesarean was more frequent among the cases than among the controls (63% vs 42% p 0.134), with an Odds Ratio (OR) of 2.35 (CI 95% 0.759- 7.319); the OR was 3.75 (CI 95% 1.002- 14.07) when a history of cesarean section was compared to no history at all. Statistically significant differences (p< .05) were found for: gestational age (38.16 vs 37.35 weeks), one previous cesarean (42% vs 18%), adhesions (79% vs 5%), VBAC (31.5% vs 3%), midline incision (16% vs 68%), Pfannenstiel incision (84% vs 32%), bleeding (744 cc vs 509 cc), and surgery time (135 vs 58 minutes), for cases with and without bladder injury, respectively. No significant differences were found in mother's age, BMI, prior surgery, preterm labor, premature rupture of membranes, height of the fetus, chorioamnioitis, pre-induction, uterine incision, urgency of the procedure, or uterine rupture. The presence of adhesions had an OR of 67.5 (CI 95% 11.14- 408).
- [Show abstract] [Hide abstract]
ABSTRACT: The incidence of surgical complications associated with cesarean section (CS) was studied prospectively in 1319 patients undergoing CS during the years 1978, 1979 and 1980 (18% of all deliveries). The overall complication rate was 11.6% (9.5% patients with minor complications and 2.1% with major complications). The complication rate for emergency operations was 18.9% and for elective CS, 4.2%--a highly significant difference. (p less than 0.001). Six risk factors were associated with the occurrence of surgical complications in emergency cases: Station of the presenting part of the fetus in relation to the spinal plane (p less than 0.001), labor prior to surgery (p less than 0.001), low gestational age (less than 32 weeks) (p less than 0.001), rupture of fetal membranes (with labor) prior to surgery (p less than 0.01), previous CS (p less than 0.01), and skill of the operator (p less than 0.05). However, no such risk factors were found in the elective group. The clinical relevance of these findings is summarized in two conclusions. Firstly, the proportion of emergency operations needs to be reduced, either in favor of elective procedures, or by allowing more patients to give birth by the vaginal route. Secondly, emergency CS requires great skill on the part of the surgeon, and should therefore not be entrusted to young, inexperienced obstetricians.Acta Obstetricia Et Gynecologica Scandinavica 02/1984; 63(2):103-8. · 1.85 Impact Factor