Impact of a Bladder Flap on Cesarean Scar Niche Development
Montefiore Medical Center
Summary
The goal of this trial is to examine if the completion or omission of a bladder flap impacts the location and formation of cesarean scar niche in women undergoing primary cesarean section. The main question it aims to answer is if omission of a bladder flap changes the prevalence of cesarean scar niche on a 6-8 week postpartum ultrasound. Researchers will compare participants that have a bladder flap made to those that have a bladder flap omitted at time of their primary cesarean delivery. Participants will have routine postpartum care and be asked to return for a 6-8 week postpartum transvaginal ultrasound.
Description
As the rate of cesarean deliveries increases globally, the importance of a cesarean scar niche (CSN) has evolved into a significant clinical concern with long term obstetric and gynecologic implications including increasing risk for placenta accreta spectrum (PAS) in future pregnancies and abnormal uterine bleeding. In fact, the main cause of PAS is placentation into uterine scars secondary to cesarean deliveries Bladder flap formation is a standard step in cesarean deliveries and involves dissecting the bladder off the uterus to push it inferiorly to allow better access to the lower uterine…
Eligibility
- Age range
- 18+ years
- Sex
- Female
- Healthy volunteers
- No
Inclusion Criteria: * Age 18 years or older * Primary low transverse cesarean section performed at Montefiore Weiler or Wakefield Hospitals * Able to provide informed consent in English or Spanish * Plan for postpartum care at Montefiore Medical Center Exclusion Criteria: * History of a prior uterine surgery * Known congenital uterine anomalies * Inability to safely access lower uterine segment at time of delivery * Hysterotomy is extended past/outside the lower uterine segment at time of surgery * Hysterectomy is indicated prior to postpartum follow-up
Interventions
- ProcedureBladder flap formation
Participants in this arm will have a bladder flap completed at the time of their cesarean delivery.
Locations (2)
- Jack D. Weiler Hospital - Einstein CampusThe Bronx, New York
- Montefiore Einstein Hospital - Wakefield CampusThe Bronx, New York