A woman has her third consecutive cesarean section. The surgeon notes that the lower uterine segment is thin, adherent to the bladder, and the serosa appears scarred. The most feared intraoperative complication specific to this scenario is:

• A Bladder injury due to abnormal placentation (placenta accreta spectrum) ✓
• B Uterine atony
• C Wound dehiscence
• D Amniotic fluid embolism

Explanation

Each repeat cesarean section increases the risk of placenta accreta spectrum (PAS) disorders due to uterine scarring. The risk of PAS increases from <1% with one prior CS to >6% with three prior CS. Bladder injury occurs in up to 6% of PAS cases due to the placenta invading the bladder. Preoperative planning with a multidisciplinary team and possible cystoscopy/urological standby is essential.

Reference: Williams Obstetrics, 26th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.