Prognostic value of the proper timing of bladder dissection in surgical management of placenta accreta spectrum. A randomized controlled trial

Background and aim: the management of PAS during CD is already a challenge owing to the presence of maternal comorbidities and suspected mortality. This study aimed to determine proper timing of bladder dissection during CD thus improving the outcome via decreasing blood loss and urinary tract injuries. Methods: a randomized controlled trial included 100 patients planned for elective CD at Mansoura University Hospitals, Egypt from July 2020 to July 2021. They were assigned into two equal groups. Group 1, bladder was dissected earlier before uterine incision meanwhile in group 2, bladder was dissected late after uterine incision and fetal extraction. Outcome measures were intra and postoperative blood loss, pre and postoperative hemoglobin levels, associated urinary tract injuries and emergent hysterectomy. Results: baseline patients’ characteristics did not show any The mean estimated blood loss during and after cesarean there was more urinary bladder injuries and emergent irrelevant differences regarding the need for platelet or Voluven transfusion, postoperative Hb level, maternal or neonatal ICU admission, PPH, fever or hospital stay time Conclusion: surgical management of PAS by CD proved