URINARY TRACT INJURIES DURING TREATMENT OF PATIENTS WITH MORBIDLY ADHERENT PLACENTA AT A TERTIARY CARE HOSPITAL, KARACHI

Abstract

Background:
Morbidly adherent placenta (MAP), also known as placenta accreta spectrum, is an increasingly recognized obstetric complication due to rising cesarean section rates. Surgical management of MAP is technically challenging and is frequently associated with injury to adjacent pelvic organs, particularly the urinary tract, leading to significant maternal morbidity.

Objective:
To determine the frequency of urinary tract injuries and identify associated risk factors during the surgical management of patients with morbidly adherent placenta at a tertiary care hospital in Karachi.

Methods:
This prospective observational study was conducted in the Department of Obstetrics and Gynecology at a tertiary care hospital over a period of one year. A total of 120 pregnant women diagnosed with morbidly adherent placenta (via ultrasound and/or MRI) and undergoing planned surgical management were included. Data regarding patient demographics, obstetric history, placental characteristics, and intraoperative findings were recorded. Urinary tract injuries, including bladder and ureteric injuries, were documented. Statistical analysis was performed using SPSS version 25, with a p-value ≤0.05 considered significant.

Results:
Urinary tract injuries were observed in 18 (15%) patients. Bladder injuries accounted for the majority (12.5%), while ureteric injuries were less frequent (2.5%). A statistically significant association was found between urinary tract injuries and higher number of previous cesarean sections (p=0.01), anterior placental location (p=0.03), and placenta percreta (p=0.002). The risk of injury increased markedly in patients with three or more prior cesarean deliveries.

Conclusion:
Urinary tract injuries are a notable complication in the surgical management of morbidly adherent placenta, particularly in high-risk patients with multiple prior cesarean sections and advanced placental invasion. Early diagnosis, meticulous surgical planning, and a multidisciplinary approach are essential to minimize complications and improve maternal outcomes.