Increased bladder injury rate during emergency and repeat cesarean section

Area of Science:

• Obstetrics and Gynecology
• Surgical Complications
• Urology

Background:

• Bladder injury is a known complication of cesarean section (CS), with an incidence of 0.22-0.44%.
• Factors influencing bladder injury rates during CS are not well-defined.
• Understanding these factors is crucial for improving patient safety.

Purpose of the Study:

• To investigate the incidence of bladder injury in relation to CS type (scheduled vs. emergency, primary vs. repeat).
• To explore the association between bladder injury and intraoperative urology consultation.
• To examine the influence of demographic and labor factors on bladder injury risk.

Main Methods:

• Retrospective review of 8,488 cesarean section records from January 1, 2013, to December 31, 2020.
• Calculation of bladder injury incidence and recording of intraoperative urology/urogynecology consultations.
• Comparison of bladder injury rates between different CS types and analysis of associations with maternal age, BMI, and gestational age.

Main Results:

• Repeat CS significantly increased the risk of bladder injury compared to primary CS (p=0.01).
• Emergency CS also showed a significantly higher risk of bladder injury than scheduled CS (p=0.04).
• Intraoperative urology/urogynecology consultations were significantly higher in cases with bladder injury (p<0.0001), with emergency and repeat CS being significant predictors.

Conclusions:

• Bladder injury is more frequent in repeat and emergency cesarean sections.
• Patients should be informed about the elevated risks associated with repeat or emergency CS.
• Surgeons must exercise caution during these procedures and ensure diligent postoperative follow-up.