Language
English
Publication Date
10-13-2025
Journal
Journal of Clinical Medicine
DOI
10.3390/jcm14207199
PMID
41156069
PMCID
PMC12565475
PubMedCentral® Posted Date
10-13-2025
PubMedCentral® Full Text Version
Post-print
Abstract
Background/Objectives: Placenta accreta spectrum (PAS) is an obstetric condition with placental adherence to the underling myometrium characterized by significant surgical morbidity at time of delivery. PAS delivery is most commonly performed by cesarean hysterectomy. The most common morbidities associated with PAS cesarean hysterectomy are blood transfusion, intensive care unit admission and urinary tract injuries. This requires interdisciplinary team management including obstetricians and urologists. Our objective was to identify pre- and intra-operative risk factors for urologic injury in this high-risk condition.
Methods: A retrospective cohort study was performed at a single tertiary center with the Center for the Management of Placenta Accreta Spectrum disorders from 2012 to 2022. Urologic injuries were considered as injury to either the bladder or ureters. Furthermore, bladder injuries were subdivided into those inherent to the procedure (intentional cystotomy) and those considered unplanned complications (incidental cystotomy). Inclusion criteria required complete antenatal documentation for assessment, and these were accessed by electronic medical records. Multivariate analysis was performed for significant variables on univariate analysis.
Results: During the 11-year study period, 146 cases of PAS were managed by our team. Of these, 39 (26.7%) were complicated by urologic injury. Intentional cystotomies were performed in 28.2% (11/39) of cases. There were 28 (28/39, 71.8%) incidental cystotomies and 5 (5/39, 12.8%) ureteral injuries were encountered. Of note, all 5 patients with ureteral injuries also had cystotomies. Upon univariate analysis, anterior placentation (OR 2.96 [1.94, 4.67], p = 0.04), percreta by antenatal ultrasound (OR 2.59 [1.13, 5.9], p = 0.02) and >2 pre-delivery vaginal bleeding episodes (OR 4.27 [1.54, 12.16], p = 0.005) were associated with urologic injury. Multivariate analysis revealed the independent significance of these variables. Of note, the presence of zero, one, two, and all three risk factors were associated with urologic injury rates of 11.1%, 22.5%, 41.9%, and 71.4%, respectively.
Conclusions: Urologic injury during cesarean hysterectomy occurs in almost one-third of cases. Pre-operative risk factors may be used to identify those at greater risk for this surgical complication. Determining patient risk allows for the use of resources such as formal urology consultation, surgical planning, and intraoperative assistance, as well as detailed patient counseling.
Keywords
placenta accreta spectrum, urologic injury, cesarean hysterectomy, antepartum vaginal bleeding, ultrasound
Published Open-Access
yes
Recommended Citation
Mulhall, J Connor; Ireland, Kayla E; Byrne, John J; et al., "Risk Factors and Clinical Significance of Urologic Injury in Cesarean Hysterectomy for Placenta Accreta Spectrum" (2025). Faculty and Staff Publications. 5427.
https://digitalcommons.library.tmc.edu/baylor_docs/5427