Early vs Late Bladder Dissection During CS Hysterectomy in Patients With PAS With Bladder Invasion

Thirty-six singleton pregnant women with PAS and bladder invasion; total anterior or anterolateral invasion, who were scheduled for cesarean hysterectomy were randomly assigned into two equal groupsGroup 1: included 18 pregnant women scheduled for classical cesarean hysterectomy for placenta accreta with or without ligation of anterior division of internal iliac artery before cesarean section.Group 2: included 18 pregnant women scheduled for bladder last cesarean hysterectomy with or without ligation of anterior division of internal iliac artery.

Inclusion Criteria:Age: reproductive age.Pregnant with singleton living fetus.Previous one or more cesarean sections.Gestational age: > 34 weeks.Elective or non-emergency cesarean sections.Preoperative hemoglobin more than 9.5 gm/dl.Exclusion Criteria:Women with history of any medical disorder with pregnancy eg. gestational diabetes, hypertension, or anemia.