A 30-year-old woman presents for repeat caesarean section (third CS). Intraoperatively, dense bladder adhesions are encountered. The lower uterine segment appears vascular and thinned. Which initial step minimises the risk of bladder injury?

• A Inserting a urinary catheter with retrograde bladder filling to delineate bladder dome ✓
• B Sharp dissection of the vesicouterine peritoneal fold from the uterine serosa
• C Blunt dissection with the finger to separate bladder from lower segment
• D Leaving the bladder adhesion undissected and making the uterine incision higher

Explanation

When dense adhesions obscure the bladder-uterine interface in repeat caesarean section, retrograde bladder filling (injecting 200–300 mL of saline through the urinary catheter) outlines the bladder dome visually, clearly demarcating the upper margin of the bladder from the lower uterine segment before any dissection. This simple technique dramatically reduces inadvertent cystotomy. Sharp dissection without anatomical landmark identification risks bladder entry. Blunt finger dissection in scarred planes is particularly dangerous.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.