Broad Ligament Approach For Bladder Dissection To Minimize Maternal Obstetrics And Urological Morbidities During Cesarean Section In Placenta Accreta In Egyptian Setting

Background: Urinary bladder injury is one of the most common operative morbidities of cesarean section. Bladder invasion with morbidly adherent placenta occurs rarely but can cause significant morbidity and mortality both for mother and fetus. Multiple management strategies have been mentioned in literature varying from conservative to radical approaches depending upon many factors as the degree of placental invasion. Objectives: this study was conducted to evaluate the efficacy and safety of lateral approach technique through the broad ligament to avoid bladder injury during cesarean section in cases with morbidly adherent placenta. Methods: This is a prospective observational cohort study was conducted on Obstetrics and Gynecology department at Menoufia university hospital, Menoufia governorate, Egypt where 200women with placenta accrete and history of at least one Previous cesarean section allocated into two groups ,Group 1: included 100 patients while the bladder was dissected from the uterus by lateral approach technique and Group 2: included 100 patients while the bladder was dissected from the uterus by classical central approach . Incidence of intraoperative bladder, ureteric injury and caesarian hysterectomy were considered primary outcome measures where operative time, maternal morbidity and mortality, intraoperative blood loss, duration of hospital stay and late urological complications as genitourinary fistula were considered secondary outcome measures. The data analyzed by SPSS 22. Results: The overall incidence of urinary tract injury, urinary bladder injury, longer operation time , estimated blood loss, number of unit blood and plasma transfusion , Postoperative hospital stay, intensive care unit admission, Postoperative fever surgical site infection and Paralytic ileus were significantly higher in group 2 than group 1. Cesarean hysterectomy was highly significantly higher in group 2 (p- value <0.001). Conclusion: Lateral approach technique of bladder dissection was very effective in preventing maternal Obstetrics and urological morbidities during cesarean section in placenta accrete.