The incidence of bladder injury has been reported to be 0.27% for primary cesarean delivery, and 0.43%–0.81% for repeat cesarean delivery. Positively associated with bladder injury are adhesions from prior surgery, emergency delivery, labor during cesarean, and attempted vaginal birth after cesarean. We investigated bladder injuries during cesarean section, hypothesizing that most of the bladder injuries occurred during the second stage of labor.
We conducted an IRB-approved, retrospective study of cases in which women received bladder injuries during cesarean sections over the past fifteen years at a University-affiliated medical center. Statistical analysis was performed using descriptive analysis.
At our institution, the incidence of bladder injury during cesarean delivery was 0.22% overall, 0.11% for primary cesareans, and 0.49% for repeat cesareans. Among 39 cases, 28 women (72%) were multiparous, while 26 (67%) were undergoing a repeat cesarean section. Of the 22 cases in which women were in labor, 15 (68%) were in the second stage. Of 39 bladder injuries, 21 (54%) occurred during urgent cesarean sections. 27 (69%) had adhesions. 35 cases were identified intraoperatively.
Our study revealed that the majority of bladder injuries occurred in those patients who were multiparous, undergoing a repeat cesarean, had prior abdominal surgery and adhesions, were in labor, and underwent an urgent cesarean section. Of those in labor, the majority were in the second stage. Clinicians will be able to utilize this information to better manage their practices in attempt to avoid these injuries.