Effect of Bladder Dissection Timing During Cesarean Hysterectomy for Morbidly Adherent Placenta on Maternal Outcomes

Abd Elhameid, Azza Abd Elmageid; Ibrahem, Mohamed Abdel-moniem; Mohammed Alfiqi Alshireef, Ali Abdullah; Abd-Alkader, Ahmed Mohamed

doi:10.21608/zumj.2025.380092.3931

Effect of Bladder Dissection Timing During Cesarean Hysterectomy for Morbidly Adherent Placenta on Maternal Outcomes

Document Type : Original Article

Authors

¹ Professor of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig university, Egypt

² Assistant Professor of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig university, Egypt

³ 2Obstetrics and Gynecology Department, Faculty of Medicine, El-Mergib university, Libya

⁴ Lecturer of Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig university, Egypt

10.21608/zumj.2025.380092.3931

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.

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