Risk Factors for Urological Complications Associated with Caesarean Section—A Case-Control Study

The incidence, indications, risk factors and pregnancy outcomes of peripartum hysterectomy at a tertiary hospital between 2013 and 2022

OBJECTIVE

To analyze the incidence, indications, risk factors and pregnancy outcomes of postpartum hemorrhage resulting in peripartum hysterectomy (PH).

METHODS

We retrospectively reviewed patients with postpartum hemorrhage requiring surgical procedures at ≥ 28 weeks of gestation from January 1, 2013 to December 31, 2022 at a tertiary hospital in Shanghai, China. The patients were divided into a PH group and a non-PH group. Maternal clinical characteristics, the management of postpartum hemorrhage, pregnancy outcomes were compared between groups. Logistic regression was used to analyze the correlations between risk factors and PH.

RESULTS

The incidence of hysterectomy was 0.2/1000 deliveries (31/150194). The variables significantly associated with PH were placenta previa with placenta increta/percreta (OR36.26), uterine rupture (OR266.16) and an estimated blood loss ≥ 3513 mL (OR431.11). The proportion of cases involving hemorrhagic shock, disseminated intravascular coagulation, bladder injury, neonatal severe asphyxia, neonatal death and hypoxic-ischemic encephalopathy were significantly higher in the PH group (P < 0.05).

CONCLUSION

The most common indications of PH were placental pathology. Efforts should be made to reduce the rate of cesarean deliveries and uterine curettage to lower the probability of abnormal placental invasion and appropriate medical indications for trial of labor after cesarean should be strictly followed to avoid the risk of uterine rupture.

A Rare Cause of Urinary Incontinence: Vesicouterine Fistula-A Case Report

Vesicouterine fistula is a rare complication occurring mainly after cesarean sections. We present here a particular case of vesicouterine fistula (VUF) whose only symptom was urinary incontinence. We describe the diagnostic methods used and the surgical treatment used to resolve the case. A 30-year-old woman presented to the gynecology clinic with urinary incontinence that occurred 5 days postoperatively after a cesarean section. The diagnosis was made on the basis of computed tomography and cystoscopy. Treatment was surgical and consisted of excision of the fistula and suturing of the bladder and uterine wall, without interposition of the omentum. Postoperative evolution was uneventful. When the urethral catheter was removed on the 14th postoperative day, the patient presented spontaneous micturition without vaginal urine leakage. In the context of urinary incontinence after cesarean section, although it is a rare complication, we must consider the occurrence of a VUF.