Bladder filling technique to prevent complications of the urinary system during placenta accrete surgery

Placenta accrete spectrum (PAS) disorders are significant life-threatening nosology due to increased maternal morbidity and mortality in this condition. All surgical interventions in PAS can be accompanied by a high percentage of massive obstetric bleeding and a high frequency of urological complications, such as injuries of the ureter and bladder. To evaluate the effectiveness of the bladder filling technique during cesarean section and metroplasty in case of PAS we analyzed 41 women, that were delivered in Regional Perinatal Center (Rostov-on-Don, Russia) in the period from 2015 to 2018. Group I included 22 pregnant women who underwent a cesarean section followed by metroplasty using the method of intraoperative filling of the bladder with physiological saline. Group II (n = 19) underwent cesarean section with metroplasty without filling the bladder. In group I, one woman had a bladder injury, in group II -6 women, which is statistically significantly more often (p < .05). The total blood loss in group I (M ± σ) was 2177.8 ± 114.9 ml and was statistically significantly less (p < .05) compared with blood loss in group II -2545.7 ± 158.8 ml. Duration of surgery in group I (M ± σ) was 2-hour 45 ± 7.1 min; in group II -3-hour 31 ± 4.1 min. Thus, using the method of filling the bladder with physiological saline and mobilizing the bladder during cesarean section surgery with metroplasty in patients with PAS can reduce the frequency of bladder injury, the volume of intraoperative blood loss and duration of surgery.