Filling of the Urinary Bladder During Difficult Cesarean Section
Condition: Urinary Tract Injury; Cesarean Section Complications
Study type: Interventional

Summary: 
      Risk factors for bladder injury during Cesarean Section are well known. Most of cases of
      bladder injury occur in presence of previous Cesarean Sections, morbidly adherent placenta,
      or previous bladder injury. limited evidence suggest that bladder filling may decrease the
      incidence of bladder injury. n our study, we compared the outcome of urinary bladder filling
      during Cesarean Section in cases at high risk of bladder injury.
    

Detailed description: 
      In women at risk of bladder injury, such as in presence of previous Cesarean Section(s),
      there may tough adhesions between the bladder and the lower uterine segment. Trial of
      separation of the bladder in such circumstances may result in bladder injury. Filling of the
      bladder will delineate the contour of the bladder and clarify the proper plane of dissection.
      In a recent randomized clinical trial lower bladder filling resulted in non-significant
      decrease in the rate of bladder injury in women with placenta percreta. In our study, we
      compared the outcome of urinary bladder filling during Cesarean Section in cases at high risk
      of bladder injury.

      Patients and Methods Inclusion criteria: Pregnant women at gestation from 20- 41 weeks who
      have any of the following risk factors

        1. Previous Cesarean Section 3 times or more

        2. Previous history of bladder injury during Cesarean Section

        3. Operative report of extensive adhesions in the last Cesarean Section

        4. Cesarean Section for placenta accreta spectrum Methods This is a randomized controlled
           trial done at the department of Obstetrics & Gynaecology unit, South Valley University
           from August 1st, 2017until the 30th of August 2018. The research is approved by the
           Committee of Ethics for Biomedical Researches, South Valley University at June 2017. All
           cases have informed consent before inclusion in the research. Closed envelop is used to
           randomized patients to either group. Group A: are cases of Cesarean section who have the
           intervention. Group: are cases of Cesarean section who do not have the intervention.

      The intervention:

      Triple-way urethral catheter insertion before establishment of anaesthesia. Evaluation of the
      drained urine is done (including: amount, character, and simple for culture and sensitivity).
      Instillation of 200 ml sterile saline is done by 50 ml syringe through the irrigation way.
      The irrigation way is closed temporarily by artery forceps. After laparotomy the bladder may
      be deflated by 50 ml or further inflated by 50 ml if needed to allow comfortable dissection.
      All Cesarean sections in both groups are done by the same surgeon supported by the same team
      in the same hospital. The Cesarean sections are done under spinal or general anaesthesia
      through pfannenstiel's incision. The catheter is removed 12 hours after Cesarean section.
      Postoperative follow up is maintained until 3 months from the time of the Cesarean section.
    

Intervention name(s): Bladder Filling; Bladder deflation
Intervention type(s): Procedure; Procedure
Intervention description(s): Group A have a triple-way urethral catheter insertion before establishment of anaesthesia. Evaluation of the drained urine is done (including: amount, character, and simple for culture and sensitivity). Instillation of 200 ml sterile saline is done by 50 ml syringe through the irrigation way. The irrigation way is closed temporarily by artery forceps. After laparotomy the bladder may be deflated by 50 ml or further inflated by 50 ml if needed to allow comfortable dissection.; Group B have Foley's catheter is inserted as usual. The catheter is connected freely to urinary bag.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Two groups of women with difficult Cesarean Section at risk of urinary bladder injury. Group A will receive the intervention. Group B will not receive the intervention.
Masking: Double (Participant, Investigator)
Primary purpose: Prevention
Keywords: Urinary; Bladder; Injury; Cesarean