The Feasibility of Bladder Filling Technique in Reducing the Incidence of Intraoperative Bladder Injury Among Pregnant Women Undergoing Placenta Accrete Spectrum (PAS) Surgery.

Abstract

Research Aim: To determine whether or not saline bladder filling technique prevent the incidence rate of intraoperative bladder injuries among pregnant women undergoing placenta accrete spectrum (PAS) surgery. Background: PAS disorders have become more noticeable as a serious and potentially life-threatening obstetric concern due to a rise in prevalence from 0.12% to 0.31% in recent years. Intraoperative bladder injuries are frequently encountered as potential complication during PAS surgical procedures. New preventive measures, such as the bladder filling technique, seek to identify the bladder’s borders, protect it, and displace it away from the lower uterine segment during placental removal. Method: The selection process for relevant studies involved using electronic databases such as PubMed, Embase, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search was restricted to include English-language articles published between 2013 and 2023. Three randomised controlled trials (RCTs) and one retrospective cohort study investigated the effectiveness of the bladder filling technique in reducing the incidence of intraoperative bladder injury among pregnant women undergoing PAS surgery were included in this structured literature review (SLR). Findings: The primary outcome of this SLR indicates that, the utilisation of the bladder filling technique was associated with a reduced occurrence of bladder injury, with an incidence range of 4.5% to 21.9% when the bladder filling technique was utilised, in contrast to an incidence range of 13.1% to 32.4% when the bladder filling technique was not utilised. Furthermore, the utilisation of the bladder filing technique was found to be correlated with a reduced time of the surgical procedure and a decreased amount of blood loss. Conclusion: This SLR reveals that utilising the bladder filling technique during PAS surgeries decreases the occurrence of intraoperative bladder injury, which in turn reduces the occurrence of other intraoperative complications, including intraoperative blood loss. Therefore, healthcare providers and policymakers should start developing surgical protocols for the use of this technique, as it has the potential to significantly impact the outcomes of pregnant women undergoing PAS surgeries.