Preoperative ultrasound adhesion mapping and bladder localization for preventing secondary injuries in repeat cesarean sections: a single-center observational study

To characterize secondary injury types during cesarean section, analyze their etiologies, and evaluate the utility of preoperative ultrasonographic intra-abdominal adhesion mapping and bladder localization in patients undergoing repeated (two or more) cesarean sections. This single-center observational study included a retrospective case-control analysis (2010–2022) of 26 intraoperative secondary-injury cases and 58 matched controls, and a prospective observational cohort (May 2023–July 2024) of 220 women undergoing repeat (two or more) cesarean sections. The observation group received preoperative ultrasound assessment for adhesion mapping and bladder localization, while the control group received standard care. Outcomes included intraoperative indicators, neonatal Apgar scores, and secondary injury incidence. Secondary injuries included bladder injury, cervical laceration, and retroperitoneal hematoma. Multivariable analysis identified prior cesarean number and intrauterine adhesions as independent risk factors. The predictive model showed good performance (area under the curve = 0.80). The observation group had shorter incision-to-delivery time, reduced operative duration and blood loss, and higher Apgar scores (all probability values < 0.001), while secondary injury incidence did not differ significantly between groups (probability value = 0.408). Repeated cesarean sections and intrauterine adhesions (referring to adhesions within the uterine cavity) are independent risk factors for intraoperative secondary injury. Preoperative ultrasonographic adhesion mapping and bladder localization improve operative outcomes.