Presented by: Ari Luder MD
Sheba Medical Center

Introduction

Placenta accreta spectrum (PAS) is a complex obstetric condition with increasing global incidence and significant maternal morbidity and mortality rates. This study aims to evaluate the benefits of ureteral-catheter stent (UCS) insertion in reducing urological injuries and overall postoperative complications in women with placenta accreta undergoing a cesarean section.

Materials

We retrospectively reviewed medical records of women diagnosed with placenta accreta, treated at our institution between 2011 and 2022. From 2019 onwards all women with PAC were inserted a UCS. We reviewed demographics, medical history, hospital course including surgery reports, and peri-operative outcomes. We then compared maternal and urological complications based on antenatal suspicion of accreta and the insertion of a UCS as a pre-operative procedure.

Main Outcome Measures

Bladder and ureteral injuries, prolonged maternal intensive care unit admission, a high volume of blood transfusion, length of stay after surgery, short and long-term urologic complications ( bladder and ureter injury), and postoperative complications.

Results

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A total of 417 women were included in the study We identified 108 cases of placenta accreta with a UCS insertion. When accreta was suspected a UCS was scheduled for insertion. There was a significantly reduced rate of urological injuries (5/108, 4.6%) compared to cases of placenta accreta without UCS insertion (43/309, 14%) (0.009,p<0.05). Women with preoperative bilateral UC  insertion had a lower incidence of overall pot-operative complications (6/108, 5.6%) compared to women without UC (50/309, 15.6%) (0.005, p<0.05).

Conclusion

Urologic injuries are common operative complications in placenta accreta cases undergoing cesarean section. Surgeons involved in these cases need to be aware of the risks associated with urological injuries and the potential benefits of interventions such as preoperative ureteric stent placement. These findings highlight the importance of a multidisciplinary approach of obstetricians, gynecologists, and urologists in the management of placenta accreta.

Funding

None