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Incidence and risk factors of bladder injury during cesarean delivery: a cohort study

  • Maternal-Fetal Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Purpose

To identify risk factors associated with bladder injury during cesarean delivery, and to determine the frequency of associated morbidities.

Methods

Data obtained from the United States’ Health Care Cost and Utilization Project-Nationwide Inpatient Sample were used to conduct a retrospective population-wide cohort study. ICD-9 codes were used to identify women who underwent a cesarean delivery between 1999 and 2015. Subsequently, women were classified based on whether or not they experienced a bladder injury during delivery. Multivariate logistic regression was used to determine predictors of bladder injury in cesarean deliveries and to examine the associated morbidities while adjusting for baseline maternal demographics and clinical characteristics.

Results

Of 4,169,681 cesarean deliveries identified, there were 7,627 (0.2%) bladder injuries for an overall incidence of 18 per 10,000. Women ≥ 35 years were at greater risk of bladder injury 1.5 (1.4–1.6), as were women with endometriosis 2.0 (1.5–2.7) and Crohn’s disease 2.7 (1.7–4.2). Risk of bladder injury increased if the cesarean delivery was associated with placenta previa 2.2 (1.9–2.4), previous cesarean delivery 4.3 (4.1–4.6), failed instrumental delivery 4.1 (3.5–4.8), fetal distress 1.7 (1.6–1.8), failed trial of labor after cesarean delivery 1.3 (1.2–1.4), and labor dystocia 1.7 (1.6–1.8). Cesarean hysterectomies presented the greatest risk for bladder injury 37.0 (33.7–40.6). Bladder injury was associated with an increased frequency of sepsis, venous thromboembolism, peritonitis, blood transfusions and longer hospital stays.

Conclusion

Bladder injury during cesarean deliveries is a rare outcome but it is more common among women with certain demographic and clinical characteristics. Among these cases, strategies to prevent sepsis and venous thromboembolism should be considered.

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, 3755 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1E2, Canada

    Nada Ibrahim & Haim A. Abenhaim

  2. Centre for Clinical Epidemiology, Jewish General Hospital, McGill, Montreal, QC, Canada

    Andrea R. Spence, Nicholas Czuzoj-Shulman & Haim A. Abenhaim

Authors
  1. Nada Ibrahim
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  2. Andrea R. Spence
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  3. Nicholas Czuzoj-Shulman
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  4. Haim A. Abenhaim
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Contributions

All authors approved the final version of this manuscript. NI designed the study, interpreted the results, wrote the first draft, and revised subsequent drafts. AS interpreted the data and revised the paper. NCS analyzed the data, interpreted the results, and revised the paper. HAH conceived and designed the study, acquired the data, supervised the analysis, interpreted the results, and critically revised the final draft.

Corresponding author

Correspondence to Haim A. Abenhaim.

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Conflicts of interest

The authors report no conflict of interest. We had full control of all primary data and we agree to allow the Journal to review this data if requested.

Research involving human participants

This study exclusively used data from an existing administrative database. This data was publicly available; hence, according to the Tri-Council Policy Statement (2010), institutional review board approval was not required.

Informed consent

This study used publicly available data; hence, we did not personally obtain informed consent from study subjects. This would be the responsibility of the Agency for Healthcare Research and Quality (AHRQ), who sponsors the National Inpatient Sample.

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Ibrahim, N., Spence, A.R., Czuzoj-Shulman, N. et al. Incidence and risk factors of bladder injury during cesarean delivery: a cohort study. Arch Gynecol Obstet 307, 401–408 (2023). https://doi.org/10.1007/s00404-022-06447-x

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  • DOI: https://doi.org/10.1007/s00404-022-06447-x

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