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Eur J Obstet Gynecol Reprod Biol. 2011 Dec;159(2):300-4. doi: 10.1016/j.ejogrb.2011.09.001. Epub 2011 Oct 11.

Effect of avoiding bladder flap formation in caesarean section on repeat caesarean delivery.

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Department of Obstetrics & Gynaecology, Santa Maria Hospital, Bari, Italy.



To evaluate the effect of bladder flap formation (BFF) during caesarean section (CS) on the uterine scar, assessed during repeat CS.


One hundred and fifteen women undergoing their first CS were divided into two groups: 58 women had a CS with BFF (Group 1) and 57 women had a CS without BFF (Group 2). During the repeat CS, four specimens from the uterine scar from the first CS were collected from each woman, and evaluated by light microscopy and transmission electron microscopy (TEM).


Adhesions were found in 28 (48.3) women in Group 1 and 14 (24.1%) women in Group 2 (p<0.01). Of the women with adhesions in Group 1, 20 (71.4%) had mild adhesions and eight (28.6%) had severe adhesions. Of the women with adhesions in Group 2, eight (57.1%) had mild adhesions and six (42.9%) had severe adhesions. Light microscopy revealed significant differences in submesothelial fibrosis (39.6% vs 12.2%; p<0.01) and neo-angiogenesis of the mesothelial stroma (46.5% vs 21%; p<0.01) in Groups 1 and 2, respectively. TEM revealed more specimens with inflammatory cells in Group 1 compared with Group 2 {mean 29.7 [standard deviation (SD) 1.3] vs 18.2 (SD 1.9) patients; p<0.01}.


BFF during CS leads to an inflammatory and fibrotic reaction, resulting in inflammation reactive and regenerative processes, mesothelial hyperplasia and submesothelial fibrosis. CS without BFF reduces the inflammatory processes and the subsequent intraperitoneal adhesions and adhesions between the bladder and uterus.

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