Urinary Tract Injuries During Cesarean Section In Patients With Morbid Placental Adherence•

Fahmida Parveen, Farhana Shaikh, Shehnila Sheeraz

Abstract

Objective 

To find out the frequency of urinary tract injuries during cesarean section in patients with morbid placental adherence.

Study design 

Cross sectional study.

Place & Duration of study

Department of Obstetrics and Gynecology, Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro, from March 2017 to February 2020.

Methodology

Patients with suspected morbidly adherent placenta according to ultrasound and color Doppler and MRI were included in this study. Confirmation of placental adherence was done on MRI and intraoperatively. Ureter and bladder injuries were identified by methylene blue infusion through a Foley catheter. Age, parity, demographic data, BMI, radiological findings and type of surgery performed were noted. Descriptive statistics were used to present data. Statistical analysis was done by SPSS version 21.

Results

A total of 166 women visiting hospital for cesarean section with morbidly adherent placenta were managed. The mean gestational age of women was 34.5±4.5 weeks. In 68 (41%) women there was a previous history of cesarean section. In 129 (77.7%) patients cesarean section was done and 37 (22.8%) had hysterectomy. During surgery 16.8% patients had bladder injury, 9.6% had injuries to the ureter whereas 5.4% had injuries to bladder and ureter.

Conclusions

Urinary tract injuries are likely to occur in morbid adherent placenta. Urinary bladder injuries were frequent in comparison with ureteral trauma.

Key words 

Urinary tract injuries, Cesarean section, Morbid placental adherence.