Effect of Methylene Blue Bladder Instillation on Urinary Tract Injuries During Cesarean Hysterectomy for Placenta Accreta Spectrum

The Effect of Methylene Blue Bladder Instillation Versus No Intervention on Urinary Tract Injuries During Cesarean Hysterectomy for Placenta Accreta Spectrum: A Prospective Cohort Study

This prospective cohort study aims to evaluate whether preoperative bladder filling with methylene blue dye can reduce the incidence of urinary tract injuries during cesarean hysterectomy in patients diagnosed with placenta accreta spectrum. A total of 60 patients will be randomly assigned to either an intervention group receiving methylene blue bladder instillation or a control group receiving standard surgical care. The primary outcome is the rate of intraoperative urinary tract injuries. Secondary outcomes include total operative time, , and pre and post operative hemoglobin level , number of units of packed RBCs transfused, number of units of fresh frozen plasma transfused, number of participants admitted to ICU postoperatively,number of participants with postoperative complications, duration of hospital stay of participants.

Inclusion Criteria:

• Age 18-45 years
• Pregnant women diagnosed antenatally with placenta accreta spectrum (PAS).
• Pregnant women with history of previous one or more caesarian deliveries .
• Planned cesarean hysterectomy at ≥33 weeks of gestation.
• Singleton pregnancy.
• BMI <35 kg/m²
• Suitable for standardized General anaesthesia

Exclusion Criteria:

• Previous bladder surgery or known urologic abnormalities.
• Bleeding tendency disorder
• Renal failure .
• Allergy to methylene blue dye.
• Emergency hysterectomy without time for protocol preparation.
• Conservative uterine- preservation management.
• Refusal or inability to provide informed written consent