title: Is the formation of a bladder flap at cesarean necessary? A randomized trial.
abstract: OBJECTIVE
  To evaluate the effects of not forming a bladder flap at lower-segment cesarean delivery.
  
  
  METHODS
  A total of 102 women who underwent cesarean delivery were prospectively randomized to one of two groups. In the study group (n = 53), a cesarean was performed without formation of a bladder flap. In the control group (n = 49), cesarean was performed with formation of a bladder flap before the uterine incision.
  
  
  RESULTS
  There were differences of median skin incision-delivery interval (5 versus 7 minutes, P <.001), median total operating time (35 versus 40 minutes, P =.004), and median blood loss (Delta hemoglobin 0.5 versus 1 g/dL, P =.009) in favor of the study group. Postoperative microhematuria was reduced in the study group (21% versus 47%, P <.01). The median need for analgesics was reduced in the study group (75.0 mg diclofenac versus 150.0 mg, P <.001), and there was a lower percentage of patients receiving analgesics 2 or more days after cesarean in the study group (26.4% versus 55.1%, P =.006). There was no difference in bowel function.
  
  
  CONCLUSIONS
  Omission of the bladder flap provides short-term advantages such as reduction of operating time and incision-delivery interval, reduced blood loss, and need for analgesics. Long-term effects remain to be evaluated.
authors.affiliation: Department of Obstetrics and Gynecology, University of Vienna (AKH), Vienna, Austria. maria.hohlagschwandtner@akh-wien.ac.at
authors.forename: M
authors.initials: M
authors.lastname: Hohlagschwandtner
authors.forename: E
authors.initials: E
authors.lastname: Ruecklinger
authors.forename: P
authors.initials: P
authors.lastname: Husslein
authors.forename: E A
authors.initials: EA
authors.lastname: Joura
mesh_terms: D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002585:Cesarean Section / Q000379:methods*; D004008:Diclofenac / Q000627:therapeutic use; D005260:Female; D006417:Hematuria; D006801:Humans; D010149:Postoperative Pain; D011183:Postoperative Complications / Q000209:etiology*; D011184:Postoperative Period; D011247:Pregnancy; D011446:Prospective Studies; D013524:Surgical Flaps / Q000009:adverse effects*; D013997:Time Factors; D001743:Urinary Bladder / Q000601:surgery*
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D004008:Diclofenac