Risk factors for bladder injury during placenta accreta spectrum surgery

Objectives To identify risk factors associated with bladder injury during placenta accreta spectrum (PAS) surgeries. Methods 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. Results 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). Conclusion 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. Synopsis Risk factors for bladder injury during placenta accreta spectrum surgery include the number of previous cesarean deliveries and a preoperative sonographic suspicion of placenta percreta.