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document
Utility of the bladder flap at cesarean delivery : a randomized controlled trial . OBJECTIVE To test the hypothesis that omission of the bladder flap in primary and repeat cesarean deliveries shortens operating time without increasing intraoperative and postoperative complications . METHODS We randomized 258 women undergoing primary and repeat cesarean deliveries at 32 weeks of gestation or more to creation ( n=131 ) or omission ( n=127 ) of the bladder flap . Emergency cesarean deliveries , planned vertical uterine incisions , and previous abdominal surgeries besides cesarean deliveries were excluded . The primary outcome measure was total operating time . Secondary outcomes were bladder injury , incision-to-delivery time , incision-to-fascial closure time , estimated blood loss , postoperative microhematuria , postoperative pain , hospital days , endometritis , and urinary tract infection . Analysis followed the intention-to-treat principle . RESULTS The median skin incision to delivery interval was shorter with omission of the bladder flap ( 9 [ range 1-43 ] compared with 10 [ range 2-70 ] minutes ; P=.04 ) , but there was no difference in total operating time ( 51 [ range 18-124 ] minutes compared with 51 [ range 16-178 ] ; P=.10 ) . No bladder injuries occurred in either group and there were no significant differences in estimated blood loss , change in hemoglobin level , postoperative microhematuria , postoperative pain , hospital days , endometritis , or urinary tract infection . CONCLUSION Omission of the bladder flap at primary and repeat cesarean deliveries does not increase intraoperative or postoperative complications . Incision-to-delivery time is shortened but total operating time appears unchanged . CLINICAL TRIAL REGISTRATION ClinicalTrials.gov , www.ClinicalTrials.gov , NCT00918996 . LEVEL OF EVIDENCE I .
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Intervention_Physical
bladder flap
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Intervention_Surgical
cesarean delivery
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Intervention_Physical
bladder flap
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Intervention_Surgical
cesarean deliveries
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Intervention_Surgical
primary and repeat cesarean deliveries
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Intervention_Physical
creation
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Intervention_Physical
omission
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Intervention_Surgical
abdominal surgeries
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Intervention_Surgical
cesarean deliveries
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Intervention_Physical
omission of the bladder flap
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Outcome_Other
total operating time .
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Outcome_Physical
bladder injury
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Outcome_Physical
incision-to-delivery time
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Outcome_Physical
incision-to-fascial closure time
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Outcome_Physical
estimated blood loss
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Outcome_Physical
postoperative microhematuria
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Outcome_Adverse-effects
postoperative pain
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Outcome_Physical
hospital days
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Outcome_Adverse-effects
endometritis
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Outcome_Adverse-effects
urinary tract infection
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Outcome_Other
median skin incision to delivery interval
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Outcome_Other
total operating time
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Outcome_Physical
bladder injuries
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Outcome_Physical
estimated blood loss
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Outcome_Physical
change in hemoglobin level
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Outcome_Physical
postoperative microhematuria
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Outcome_Adverse-effects
postoperative pain
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Outcome_Physical
hospital days
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Outcome_Adverse-effects
endometritis
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Outcome_Adverse-effects
urinary tract infection
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Participant_Sample-size
258
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Participant_Sex
women
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Participant_Condition
primary and repeat cesarean deliveries
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Participant_Sample-size
n=131
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Participant_Sample-size
n=127