الفهرس 
PATHOGENESISOnly 14 pages are availabe for public view
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Abstract
Background: Abnormally invasive placenta is a major cause of maternal morbidity and mortality. Cesarean hysterectomy is the standard surgical management However, limited data exist to guide the optimal management of this condition. The existing literature consists predominately of case reports, and studies undertaken using retrospective review of medical records, over a number of years in a single or small number of tertiary-care institutions .The aim of this study is to provide preliminary data to judge between two different approaches during cesarean section for morbidly adherent placenta, which are bladder dissection before and after uterine incision as regard operative time, blood loss and incidence of bladder injury.
Materials and methods: We performed a RCT of 60 cases of morbid placental adherence managed at Ain Shams Maternity hospital, Cairo, Egypt. We divided the cases into 2 groups, group A: 30 Patients will have bladder dissection at the start of cesarean section for morbidly adherent placenta, group B: 30 Patients will have bladder dissection after closing uterine incision and just before clamping uterine artery for cesarean hysterectomy. Main outcome measures were estimated blood loss, transfusion requirements, operative time and incidence of urological injury.
Results: The study includes 60 cases of ultrasound and Doppler diagnosed abnormally invasive placenta. The mean blood loss in group A (bladder dissected before uterine incision) is1791.17 while group B (bladder dissected after uterine incision) is 2368.33 also 33.3% of group A needed blood transfusion while 76.7% in group B. The mean operative time in minutes in group A is 139 while 166 in group B. The incidence of urological injury is 6.7% in group A and 20% in group B.
Conclusion: the study shows that dissection of the bladder before uterine incision during cesarean section of morbidly adherent placenta is associated with a less blood loss than delaying dissection after uterine incision. But there was no statistical significance between both groups as regards to incidence of urological injury and total operative time despite the noted clinical significant differences.