ObjectivesTo identify risk factors associated with bladder injury during placenta
accreta spectrum (PAS) surgeries. MethodsThis 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. ResultsA 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). ConclusionThe 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.
