Ultrasound-guided bladder localization for predicting abdominal adhesions, bladder injury, and scar healing in repeat cesarean sections: a prospective cohort study.

OBJECTIVE

To evaluate the role of ultrasound-measured uterine sliding distance combined with bladder localization in improving intraoperative safety and postoperative recovery among women undergoing repeat cesarean sections.

METHODS

This prospective cohort study enrolled 174 pregnant women undergoing repeat cesarean sections at Shijiazhuang Fourth Hospital (December 2020-August 2024). Participants were assigned either to a control group (conventional surgery) and an ultrasound-guided bladder localization (USBL) group. Preoperative high-frequency ultrasound was applied to assess uterine sliding distance and scar quality using the Patient and Observer Scar Assessment Scale (POSAS) scale. Intraoperative outcomes included estimated blood loss, operative time, and incidental injuries, which were evaluated using the revised American Society for Reproductive Medicine (rASRM) scale. Postoperative outcomes at 6 weeks included scar healing, quality of life, and complications. Statistical analysis was performed using t test, Mann-Whitney U test, Chi-square test, and Spearman's correlation, with p < 0.05 considered significant.

RESULTS

Baseline characteristics were comparable between groups (all p > 0.05). Compared with the control group, the USBL group demonstrated significantly reduced intraoperative blood loss, shorter operative time, and fewer bladder or intestinal injuries (all p < 0.05). Secondary analyses showed superior scar healing, higher quality of life, and lower incidence of stress urinary incontinence in the USBL group.

CONCLUSION

USBL, combined with preoperative assessment of uterine sliding distance, improves surgical safety and postoperative recovery in repeat cesarean sections by reducing intraoperative complications and enhancing scar healing and quality of life.