Caesarean Section And Bladder Injury

Copyright (c) 2011 Julie Glynn

According to the Royal College of Obstetricians and Gynaecologists (RCOG), caesarean sections carry a 1 in 1000 chance of bladder injury. It is, therefore, an established risk that is sometimes unavoidable. However, there are unfortunately occasions in which bladder damage is the direct result of medical negligence.

The Risk of Bladder Injury During C-Section.

Bladder injury is possible in any standard lower segment caesarean section. This is due to the nature of the operation itself. Following the opening of the abdominal wall, the peritoneum will be incised and the bladder pushed downwards, therefore exposing the uterus. The uterus is then cut and the baby delivered. It is during this movement of the bladder when many bladder injuries occur.

Thus bladder injury and disturbed urinary function is a well-known risk of caesarean section. However, this risk is significantly increased when the caesarean section is carried out at full dilation, as the operation is much more difficult to perform than an elective caesarean, or a caesarean performed in early labour. Statistics published by the Royal College of Obstetricians and Gynaecologists (RCOG) support this viewpoint:-

* Complication rates are greater in c-sections performed during labour (24 women in every 100) than planned procedures (16 women in every 100);

* Complication rates are higher at 9 to 10cm dilation (33 women in 100) when compared with 0 to 1cm dilation (17 in every 100).

But why is there an elevated risk of bladder injury when a c-section is performed a full dilation? The reason is because in the advanced stages of labour, the baby's head lies deep in the pelvis. This can make the anatomy appear distorted, making it difficult for the obstetrician to identify where, exactly, an incision should be made. If the bladder is in an abnormal position - for example, high up over the uterus - then injury is much more likely to occur. In such cases, the damage caused to the bladder would not be negligent.

Can Bladder Injury Amount to Medical Negligence?

However, there are times when a bladder injury sustained during c-section can amount to medical negligence. Firstly, if there is not an abnormal anatomy but the bladder is still cut, it will be deemed an unacceptable complication. For example, if an obstetrician simply fails to recognise the anatomy (which is not abnormal) and makes an incision through the normally situated bladder into the vagina, this will amount to medical negligence.

Secondly, a negligence claim may arise if a bladder is damaged during the operation, but is not identified at the time. This will cause a woman to have a number of serious complications, including blood clots, haemorrhage, sepsis and infection. It is likely secondary surgery will also be required.

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