{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T08:58:34Z","timestamp":1783846714238,"version":"3.55.0"},"reference-count":36,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,5,10]],"date-time":"2024-05-10T00:00:00Z","timestamp":1715299200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Intraoperative hemorrhage and peripartum hysterectomy are the main complications in patients presenting with a low\u2010lying placenta or placenta previa undergoing repeat Cesarean delivery (CD). Patients with a high probability of placenta accreta spectrum (PAS) at birth also have a higher risk of intraoperative urologic injury. The aim of this study was to evaluate the ultrasound signs and intraoperative features associated with these injuries.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective case\u2013control study of consecutive singleton pregnancies included in a prospective cohort of patients with a history of at least one prior CD and diagnosed prenatally with an anterior low\u2010lying placenta or placenta previa at 32\u201336\u2009weeks' gestation. All patients underwent investigational preoperative transabdominal and transvaginal ultrasound examination within 48\u2009h prior to delivery. Ultrasound anomalies of uterine contour and uteroplacental vascularity, and gross anomalies of the lower uterine segment (LUS) and surrounding pelvic tissue at delivery, were recorded using a standardized protocol, which included evaluation of the extent of uterine contour anomalies. The diagnosis of PAS was established when one or more placental lobules could not be separated digitally from the uterine wall at delivery or during the gross examination of the hysterectomy or partial myometrial resection specimens, and was confirmed by histopathology. Data were compared between cases complicated by intraoperative bladder injury and controls from the same cohort matched at a 1:3 ratio by parity and the number of prior CDs using conditional logistic regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 16 (9.4%) patients with an intraoperative bladder injury in a cohort of 170 managed by the same multidisciplinary team during the study period. There were no patients diagnosed with ureteric or bladder trigone damage. There were 14 (87.5%) patients  with a bladder injury that had histopathologic evidence of PAS at birth, including 11 (68.8%) cases described on microscopic examination as placenta increta and three (18.8%) as placenta creta. There was a significant (<jats:italic>P<\/jats:italic> =\u20090.03) difference between cases and controls in the distribution of  intraoperative LUS vascularity, whereby the higher the number of enlarged vessels, the higher the odds of bladder injury. Multivariable regression analysis revealed that both gestational age at delivery and LUS remodeling on transabdominal ultrasound were associated with bladder injury. A higher gestational age was associated with a lower risk of injury. A higher LUS remodeling grade on transabdominal ultrasound was associated with an increased risk of bladder injury. Patients with Grade\u20103 remodeling (involving &gt;\u200950% of the LUS) had 9\u2010times higher odds of a bladder injury  compared to patients with Grade\u20101 remodeling (involving &lt;\u200930% of the LUS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Preoperative ultrasound examination is useful in the evaluation of the risk of intraoperative bladder injury in patients with a history of prior CD presenting with a low\u2010lying placenta or placenta previa. The larger the remodeling of the LUS on transabdominal ultrasound, the higher the risk of adverse urologic events. \u00a9 2024 The Authors. <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic> published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.27590","type":"journal-article","created":{"date-parts":[[2024,1,20]],"date-time":"2024-01-20T14:49:25Z","timestamp":1705762165000},"page":"781-788","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Evaluation of preoperative ultrasound signs associated with bladder injury during complex Cesarean delivery: case\u2013control study"],"prefix":"10.1002","volume":"63","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0003-2366","authenticated-orcid":false,"given":"A. M.","family":"Hussein","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kasr Al Ainy School of Medicine University of Cairo  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Thabet","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kasr Al Ainy School of Medicine University of Cairo  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. A.","family":"Elbarmelgy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kasr Al Ainy School of Medicine University of Cairo  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1474-3433","authenticated-orcid":false,"given":"R. M.","family":"Elbarmelgy","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Kasr Al Ainy School of Medicine University of Cairo  Cairo Egypt"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-7737","authenticated-orcid":false,"given":"E.","family":"Jauniaux","sequence":"additional","affiliation":[{"name":"EGA Institute for Women's Health, Faculty of Population Health Sciences University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,5,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.02.021"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2022.02.038"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.12.030"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.23732"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1002494"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.12407"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.08.056"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/ajcp\/aqaa080"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2021.03.019"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17568"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26299"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.7863\/ultra.33.5.745"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-020-05707-y"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2019.11.1246"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.08.026"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26155"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.1992.11.7.333"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2023.05.004"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20246"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.17286"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.26196"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.20381"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.placenta.2023.08.066"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-023-05923-9"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(66)90661-2"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13547"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318273695b"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0705.1996.07010058.x"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2021.08.010"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/ijgo.14567"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000005075"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.24890"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.14112"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.101017"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2022.09.021"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.27453"}],"container-title":["Ultrasound in Obstetrics &amp; 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