Friedrich Lior, Mor Nizan, Weissmann-Brenner Alina, Kassif Eran, Friedrich Shakad Noah, Weissbach Tal, Castel Elias, Levin Gabriel, Meyer Raanan
The Joyce & Irving Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Int J Gynaecol Obstet. 2023 Jun;161(3):911-919. doi: 10.1002/ijgo.14567. Epub 2022 Nov 28.
To identify risk factors associated with bladder injury during placenta accreta spectrum (PAS) surgeries.
This retrospective cohort study was conducted at the Chaim Sheba Medical Center. The study population included pregnant women diagnosed with PAS undergoing uterine-preserving surgery or hysterectomy. Women with and without operative bladder injury were compared by univariate analysis followed by multivariate analysis. A sub-analysis of women without preoperative sonographic suspicion of bladder invasion was performed.
A total of 312 women were included in the study. Bladder injury incidence was 9.3% (n = 29). Uterine preservation was performed in 267/312 (85.6%) women. The number of previous cesarean deliveries and a preoperative sonogram suspicious for placenta percreta were found to be independent risk factors for intraoperative bladder injury (odds ratio [OR] 1.30, P = 0.019, and OR 5.23, P = 0.002, respectively). The number of previous cesarean deliveries and preoperative sonographic suspicion of placenta percreta were also associated with bladder injury in the sub-analysis (OR 1.30, P = 0.044 for previous cesarean deliveries, and OR 3.36, P = 0.036, for preoperative suspicion of bladder injury).
The number of previous cesarean deliveries and preoperative suspicion of placenta percreta are preoperative factors that can assist in preoperative planning and intraoperative management of PAS cases.
确定与胎盘植入谱系疾病（PAS）手术期间膀胱损伤相关的危险因素。
这项回顾性队列研究在Chaim Sheba医疗中心进行。研究人群包括被诊断为PAS并接受保留子宫手术或子宫切除术的孕妇。对有和没有手术膀胱损伤的女性进行单因素分析，然后进行多因素分析。对术前超声未怀疑膀胱受侵的女性进行亚组分析。
共有312名女性纳入研究。膀胱损伤发生率为9.3%（n = 29）。267/312（85.6%）名女性接受了子宫保留手术。既往剖宫产次数和术前超声检查怀疑胎盘穿透是术中膀胱损伤的独立危险因素（比值比[OR]分别为1.30，P = 0.019和OR 5.23，P = 0.002）。在亚组分析中，既往剖宫产次数和术前超声检查怀疑胎盘穿透也与膀胱损伤相关（既往剖宫产次数的OR为1.30，P = 0.044；术前怀疑膀胱损伤的OR为3.36，P = 0.036）。
既往剖宫产次数和术前怀疑胎盘穿透是术前因素，可有助于PAS病例的术前规划和术中管理。
