Sectio caesarea ohne Blasenpräparation: Eine sonographische Nachuntersuchung

Purpose: To evaluate the incidence of hematomas after cesarean section with and without formation of a bladder flap, since non-formation reduces blood loss. Material and Methods: At the university hospital of Vienna 64 women undergoing cesarean delivery were randomly included into the study. In the study group (n = 31) cesarean section was performed with a Pfannenstiel and a low transverse uterine incision about 1 cm above the vesicouterine peritoneal fold, and without prior dissection and formation of a bladder flap. In the control group (n=33) a common formation of a bladder flap was performed. All women underwent transabdominal and transvaginal ultrasound on the 5th day after delivery. Hematomas were defined as a inhomogeneous area ≥2 cm in diameter in relation to the uterine incision. Results: No significant differences concerning sonographically diagnosed hematomas were found between the two groups (23% vs. 30%, p=0.27). Operating time, bloodloss, and microhematuria were decreased in favor of the study group. No woman demonstrated postoperative fever. Conclusion: Hematomas are common sonographic findings after cesarean section. Analogue to the reduced bloodloss a trend towards a lower incidence of hematomas was found after omission of the bladder flap. This fact was not of clinical importance in the study, but indicates less trauma.