الفهرس 
Morbid Placental AdherenceOnly 14 pages are availabe for public view
 |  | from | 189 |  |  |
| | | from | 189 | | |
Abstract
IMPORTANCE : we will try to find the incidence of Lower Urinary Tract Injuries and theirs relationship with risk factors and also theirs medical complications.
OBJECTIVE : evaluate cases of Lower Urinary Tract injuries during cesarean section withor without hysterectomy in cases with morbid placental adherence.
METHODS: Retrospective Cohort Study. This study is carried out in department of Obstetricsand Gynecology, Ainshams University Maternity Hospital in Cairo, Egypt from the period of 2012 till 2014 .These patients are enrolled in four groups:group 1: Cases without urinary tract injuries.group 2: Cases with injuries of the bladder. group 3: Cases with injuries of the ureter.
group 4: Cases with injuries to the bladder and ureter.
RESULTS : The incidence of Urinary Tract injuries during cesarean section with morbid adherence placenta is 21.7 % (Bladder 11.7 %,
Ureter 4.7 % and bladder with ureter 5.3 % ). There are various type of repair of urinary tract injury ,as the following, bladder repair 10.8 %, ureteric 38 catheterization 0.9 %, uretero-vesical repair or reimplantation 1.5 %, bladder repair and uretrovesical 1.2%, bladder repair and ureteric catheterization 2.3% ,ureteric catheterization and uretrovesical 1.5% and 6.4% of cases needed urologic consultations .The are real relation between Urinary tract injuries and obesity (55.3%) . We have Bladder invasion in only 26.9 % of all cases according to sonograghy findings. The most of cases were terminated by Cesarean section in 67.5 % and the remainders were terminated by Cesarean Hysterectomy 32.5 %. The Maternal Mortality Rate in this study was (1.2 %) and about 28.9 % of cases need to ICU admission. About 96.5 % of cases needed blood transfusion .
CONCLUSIONS: The morbid adherent placenta is still really a challenge, which is facing us as obstetricans, due to highly morbidity and mortality. The good procedures will be done by Multidisciplinary team, which is the golden management antenatal to avoid complication of this cases.When morbid adherent placenta is diagnosed or suspected antenatally, the patient must be referred to a tertiary center. Residency program is needed to train residents on different methods to avoid urinary tract injury during cesarean section for morbid placental adherence .