Is the Formation of a Bladder Flap at Cesarean Necessary? A Randomized Trial

In Brief OBJECTIVE To evaluate the effects of not forming a bladder flap at lower-segment cesarean delivery. METHODS A total of 102 women who underwent cesarean delivery were prospectively randomized to one of two groups. In the study group (n = 53), a cesarean was performed without formation of a bladder flap. In the control group (n = 49), cesarean was performed with formation of a bladder flap before the uterine incision. RESULTS There were differences of median skin incision-delivery interval (5 versus 7 minutes, P < .001), median total operating time (35 versus 40 minutes, P = .004), and median blood loss (Δ hemoglobin 0.5 versus 1 g/dL, P = .009) in favor of the study group. Postoperative microhematuria was reduced in the study group (21% versus 47%, P < .01). The median need for analgesics was reduced in the study group (75.0 mg diclofenac versus 150.0 mg, P < .001), and there was a lower percentage of patients receiving analgesics 2 or more days after cesarean in the study group (26.4% versus 55.1%, P = .006). There was no difference in bowel function. CONCLUSION Omission of the bladder flap provides short-term advantages such as reduction of operating time and incision-delivery interval, reduced blood loss, and need for analgesics. Long-term effects remain to be evaluated. Omission of the bladder flap at cesarean reduces operating time, blood loss, and postoperative pain.