Comparison between Bladder Dissection Before and After Uterine Incision during Cesarean Section for Morbidly Adherent Placenta, A Randomized Controlled Study

Abstract

bnormally invasive placenta is a major cause of maternal morbidity and mortality. Cesarean hysterectomy is the standard surgical management. However, limited data exist to guide the optimal management of this condition. The existing literature consists predominately of case reports, and studies undertaken using retrospective review of medical records, over a number of years in a single or small number of tertiary-care institutions. The aim of this study is to provide preliminary data to judge between two different approaches during cesarean section for morbidly adherent placenta, which are bladder dissection before and after uterine incision as regard operative time, blood loss and incidence of bladder injury. We performed a RCT of 60 cases of morbid placental adherence managed at Ain Shams Maternity hospital, Cairo, Egypt. We divided the cases into 2 groups, Group A: 30 Patients will have bladder dissection at the start of cesarean section for morbidly adherent placenta, Group B: 30 Patients will have bladder dissection after closing uterine incision and just before clamping uterine artery for cesarean hysterecto