title: Choice of abdominal incision and risk of trauma to the urinary bladder and bowel in multiple cesarean sections.
abstract: OBJECTIVE
  To determine if the midline subumbilical incision reduces the risk of trauma to bladder and bowel in women undergoing multiple cesarean sections.
  
  
  METHODS
  Retrospective analysis of hospital histories of 3164 women who had repeat cesarean sections at a referral maternity hospital.
  
  
  METHODS
  The clinical records of women who had between one and eight cesarean sections over a 4-year period to October 2002 were examined for entries on injury to bladder and bowel. The frequency of these injuries in relation to abdominal incision used was determined. Multiple logistic regression analysis was performed to assess the influence of cesarean number, abdominal incision, intraperitoneal adhesions, operator experience, and anterior placenta previa on risk of bladder injury.
  
  
  METHODS
  Frequency of trauma to bladder and bowel associated with either Pfannenstiel or midline incision.
  
  
  RESULTS
  There were 3164 women who met the inclusion criteria to the study. The midline incision was associated with significantly higher risk than Pfannenstiel for injury to the bladder (P<0.0001, OR 6.7, 95% CI 2.6-16.5). For both incisions, injury to the bladder increased with rising cesarean number. In addition, for a given cesarean other than primary, bladder trauma was more likely with the midline incision. The risk of injury to bowel was higher with the midline incision (RR 5.5), but there were too few events to permit Chi square analysis.
  
  
  CONCLUSIONS
  In repeat cesarean section, the midline incision is associated with a higher risk of bladder and bowel injury than Pfannenstiel.
authors: Department of Obstetrics and Gynecology, Maternity and Children's Hospital, Jeddah, Saudi Arabia. fmakoha@yahoo.com
authors: Frederick W
authors: FW
authors: Makoha
authors: Maha A
authors: MA
authors: Fathuddien
authors: Hanan M
authors: HM
authors: Felimban
mesh_terms: D000005:Abdomen / Q000601:surgery*; D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D041981:Gastrointestinal Tract / Q000293:injuries* / Q000473:pathology; D006801:Humans; D011247:Pregnancy; D012044:Regression Analysis; D012189:Retrospective Studies; D012306:Risk; D000267:Tissue Adhesions; D001743:Urinary Bladder / Q000293:injuries*