ABSTRACT
OBJECTIVE: To identify risk factors for bladder injury during cesarean delivery, to let patients and doctors know them and their importance. METHODS: We conducted a case-control study of women undergoing cesarean delivery at the Instituto Nacional de PerinatologíaIsidro Espinosa de los Reyes between January 2001 and December 2007. Cases were women with bladder injuries at the time of cesarean section. Two controls per case were selected randomly. Medical records were reviewed for clinical and demographic data to compare them. RESULTS: Twenty-one bladder injuries were identified among 24, 057 cesarean sections, (incidence 0.087%), only 19 were analized. Prior cesarean section was more prevalent among cases than controls (63% vs 42% p 0.134), with an OR of 2.35 (95% CI 0.759-7.319), when we take only patients with one cesarea in contrast with no cesarea the OR is 3.75 (95% CI 1.002- 14.07). Statistically significant differences (P values < .05) between cases and controls were found in gestacional age (38.16 vs 37.35 weeks), prior cesareans (42% vs 18%), adhesions (79% vs 5%), Odds ratio of 67.5 (95% CI 11.14- 408), VBAC (31.5 vs 3%), median skin incisión (16% vs 68%), Pfannenstiel (84% vs 32%), blood loss (744cc vs 509cc) and length of surgery 135 vs 58 minutes). No differences were found among age, BMI, prior surgery, labor, premature rupture of membranes, station, chorioamnioitis, induction, uterine incision, timing of delivery, uterine rupture. CONCLUSION: Prior cesarean section and adhesions are risk factors for bladder injury at the time of repeat cesarean delivery. Elective cesarean delivery is valid but it is duty of physicians to inform patients the risks of it.
Subject(s)
Cesarean Section , Intraoperative Complications/epidemiology , Urinary Bladder/injuries , Adult , Case-Control Studies , Female , Humans , Intraoperative Complications/etiology , Retrospective Studies , Risk FactorsABSTRACT
Objetivo: Identificar los factores de riesgo para lesión vesical durante la operación cesárea. Material y métodos: Se realizó un estudio de casos y controles de mujeres sometidas a cesárea en el periodo comprendido entre el 1 de enero de 2001 y el 31 de diciembre de 2007 en el INPerIER. Los casos fueron mujeres que habían sufrido lesión vesical en el procedimiento, como controles se seleccionaron al azar 2 mujeres por caso a las que se les realizó cesárea sin lesión vesical en el mismo periodo de tiempo. Se revisaron los expedientes analizando las características demográficas y clínicas las cuales se compararon entre sí. Resultados: Se encontraron 21 lesiones vesicales entre 24,057 cesáreas (incidencia 0,087%), de las cuales sólo se analizaron 19. La cesárea previa fue más frecuente en los casos que en los controles (63% vs 42% p 0,134), con un Odds Ratio (OR) de 2,35 (IC 95%0,759- 7,319), al comparar el antecedente de una cesárea contra ninguna el OR resultó de 3,75 (IC 95% 1,002- 14,07). Se encontraron diferencias estadísticamente significativas (p<,05) en: edad gestacional (38,16 vs 37,35 semanas), una cesárea previa (42% vs18%), adherencias (79% vs 5%), VBAC (31,5% vs 3%), incisión media (16% vs 68%), incisión Pfannenstiel (84% vs 32%), hemorragia (744cc vs 509cc) y tiempo quirúrgico (135 vs 58 minutos), con lesión vesical y sin ella respectivamente. No se encontraron diferencias significativas en la edad materna, el IMC, cirugías previas, TDP, RPM, altura del feto, corioamnioitis, preinducción, incisión uterina, urgencia del procedimiento o ruptura uterina. La presencia de adherencias tuvo un OR de 67,5 (IC 95% 11,14- 408). Conclusiones: El antecedente de cesárea y de adherencias son factores de riesgo para lesión vesical durante la cesárea (AU)
Objective: To identify risk factors for bladder injury during cesarean delivery, to let patients and doctors know them and their importance. Methods: We conducted a case-control study of women undergoing cesarean delivery at the Instituto Nacional de Perinatología Isidro Espinosa de los Reyes between january 2001 and december 2007. Cases were women with bladder injuries at the time of cesarean section. Two controls per case were selected randomly. Medical records were reviewed for clinical and demographic data to compare them. Results: Twenty-one bladder injuries were identified among 24, 057 cesarean sections, (incidence 0.087%), only 19 were analized. Prior cesarean section was more prevalent among cases than controls (63% vs 42% p 0.134), with an OR of 2.35 (95% CI 0.759-7.319), when we take only patients with one cesarea in contrast with no cesarea the OR is 3.75 (95% CI 1.002- 14.07). Statistically significant differences (P values < .05) between cases and controls were found in gestacional age (38.16 vs 37.35 weeks), prior cesareans (42% vs 18%), adhesions (79% vs 5%), Odds ratio of 67.5 (95% CI 11.14- 408), VBAC (31.5 vs 3%), median skin incisión (16%vs 68%), Pfannenstiel (84% vs 32%), blood loss (744cc vs 509cc) and length of surgery 135 vs 58 minutes). No differences were found among age, BMI, prior surgery, labor, premature rupture of membranes, station, chorioamnioitis, induction, uterine incision, timing of delivery, uterine rupture. Conclusion: Prior cesarean section and adhesions are risk factors for bladder injury at the time of repeat cesarean delivery. Elective cesarean delivery is valid but it is duty of physicians to inform patients the risks of it (AU)
