Risk Factors for Urological Complications Associated with Caesarean Section-A Case-Control Study

Area of Science:

• Urology
• Obstetrics & Gynecology
• Surgical Complications

Background:

• Urologic complications, such as bladder and ureteric injuries, are rare but serious risks during caesarean sections (CS).
• Inadequate management of these injuries can lead to increased maternal morbidity and long-term adverse outcomes.
• Identifying risk factors is crucial for proactive management and patient counseling.

Purpose of the Study:

• To identify specific risk factors associated with urologic injuries occurring during caesarean section (CS).
• To provide data for obstetricians and patients to understand and plan for potential risks.
• To inform strategies for mitigating these surgical complications.

Main Methods:

• A case-control study was conducted over four years (2016-2019) at a tertiary university center.
• Cases included patients with urologic injuries during CS; controls were matched 1:3 for uncomplicated CS.
• Data were collected from electronic medical records and operative reports, with statistical analysis to identify risk factors.

Main Results:

• The incidence of urologic complications during CS was 0.25% (36 of 14,340 patients).
• Risk factors identified include advanced maternal age, lower gestational age, lower birth weight, and higher prevalence of prior CS, placenta accreta, and central previa.
• Prior CS and caesarean hysterectomy were confirmed as significant risk factors for urologic injuries.

Conclusions:

• Prior caesarean section (CS) is the primary risk factor for urologic injuries during subsequent CS procedures.
• Patients with a history of CS undergoing caesarean hysterectomy for placenta previa central or placenta accreta are at elevated risk.
• These complex cases may involve significant bladder and ureteric injuries, necessitating careful surgical planning and hemostasis.