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Impact of a Bladder Flap on Cesarean Scar Niche Development (B-FIND)

4 giugno 2026 aggiornato da: Montefiore Medical Center
The goal of this trial is to examine if the completion or omission of a bladder flap impacts the location and formation of cesarean scar niche in women undergoing primary cesarean section. The main question it aims to answer is if omission of a bladder flap changes the prevalence of cesarean scar niche on a 6-8 week postpartum ultrasound. Researchers will compare participants that have a bladder flap made to those that have a bladder flap omitted at time of their primary cesarean delivery. Participants will have routine postpartum care and be asked to return for a 6-8 week postpartum transvaginal ultrasound.

Panoramica dello studio

Stato

Non ancora reclutamento

Condizioni

Intervento / Trattamento

Descrizione dettagliata

As the rate of cesarean deliveries increases globally, the importance of a cesarean scar niche (CSN) has evolved into a significant clinical concern with long term obstetric and gynecologic implications including increasing risk for placenta accreta spectrum (PAS) in future pregnancies and abnormal uterine bleeding. In fact, the main cause of PAS is placentation into uterine scars secondary to cesarean deliveries

Bladder flap formation is a standard step in cesarean deliveries and involves dissecting the bladder off the uterus to push it inferiorly to allow better access to the lower uterine segment for hysterotomy and decrease risk of bladder injury. The lower uterine segment is targeted for hysterotomy as it has been shown that the proportion of muscle tissue and the thickness of the wall of the uterus increases as one travels from the cervix to the fundus. Therefore, by making an incision in the lower uterine segment, the surgeon has less tissue to go through to deliver the fetus and disrupts less muscle to preserve uterine myometrial integrity. While studies have suggested bladder flap omission in primary cesarean deliveries does not increase intraoperative complications and reduces operating time. CSN assessment was not an outcome evaluated in these studies and the decision to omit or perform a bladder flap is at the discretion of the surgeon.

Previous studies have looked at different surgical techniques and different cervical dilations at time of cesarean delivery and the impact on niche formation and location. There has been no consensus on hysterotomy or other surgical techniques to decrease risk of CSN formation. To our knowledge, there have not been studies that have assessed postoperative CSN in relation to completion or omission of a bladder flap prior to hysterotomy. As such, the investigator team hypothesizes that omission of a bladder flap lends itself to a more cephalad hysterotomy and potentially more clinically significant CSNs.

Tipo di studio

Interventistico

Iscrizione (Stimato)

130

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Contatto studio

Luoghi di studio

  • Stati Uniti
    • New York
      • The Bronx, New York, Stati Uniti, 10461
        • Jack D. Weiler Hospital - Einstein Campus
        • Contatto:
      • The Bronx, New York, Stati Uniti, 10466
        • Montefiore Einstein Hospital - Wakefield Campus
        • Contatto:

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Adulto
  • Adulto più anziano

Accetta volontari sani

No

Descrizione

Inclusion Criteria:

  • Age 18 years or older
  • Primary low transverse cesarean section performed at Montefiore Weiler or Wakefield Hospitals
  • Able to provide informed consent in English or Spanish
  • Plan for postpartum care at Montefiore Medical Center

Exclusion Criteria:

  • History of a prior uterine surgery
  • Known congenital uterine anomalies
  • Inability to safely access lower uterine segment at time of delivery
  • Hysterotomy is extended past/outside the lower uterine segment at time of surgery
  • Hysterectomy is indicated prior to postpartum follow-up

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Prevenzione
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Nessun intervento: Bladder flap omission
Participants randomized to this arm will have the bladder flap step omitted prior to low transverse hysterotomy formation. Participants will not need to alter their postoperative or postpartum care.
Sperimentale: Bladder flap formation
Participants randomized to this arm will have a bladder flap formed using standard procedure during the cesarean delivery prior to low transverse hysterotomy and delivery of the infant. As with the 'Bladder flap omission' arm, participants will not need to alter their postoperative or postpartum care.
Procedura: Bladder flap formation
Participants in this arm will have a bladder flap completed at the time of their cesarean delivery.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Presence of cesarean scar niche
Lasso di tempo: From enrollment to transvaginal ultrasound, completed approximately 6-8 weeks postpartum
A dichotomous measure of the presence or absence of a cesarean scar niche, as defined by a residual myometrial thickness of <3mm at the scar level, detected on transvaginal ultrasound. The presence of a cesarean scar niche increases risk for gynecologic complaints and abnormal placentation in subsequent pregnancies.
From enrollment to transvaginal ultrasound, completed approximately 6-8 weeks postpartum

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Distance of cesarean scar niche from internal os
Lasso di tempo: From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Sonographic distance of cesarean scar niche from internal cervical os, measured in millimeters, on postpartum transvaginal ultrasound. The investigator team hypothesizes that a scar further from the internal os has increased risk for abnormal placentation in future pregnancies.
From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Size of cesarean scar niche
Lasso di tempo: From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Sonographic dimensions of length and width of cesarean scar niche, measured in mm, on transvaginal ultrasound. The investigator team hypothesizes that larger niches are associated with increased risk of abnormal placentation in future pregnancies and increased risk of future gynecologic complaints.
From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Measurement of residual myometrium
Lasso di tempo: From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Sonographic measurement of residual myometrium in mm by transvaginal ultrasound. Thinner residual myometrium may imply a larger defect, increased risk for abnormal placentation or formation of a uterine window in future pregnancies.
From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Size of cesarean scar defect in subsequent pregnancy
Lasso di tempo: From time of enrollment to time of subsequent pregnancy, up to 5 years following baseline pregnancy
Sonographic measurement of dimensions (length and width) of cesarean scar defect in subsequent pregnancy, measured in mm, to assess if larger postpartum niches are associated with larger defects in subsequent pregnancies as they may carry increased risk of morbidity in the pregnancy.
From time of enrollment to time of subsequent pregnancy, up to 5 years following baseline pregnancy
Cases of abnormal placentation in subsequent pregnancies
Lasso di tempo: From time of enrollment to time of subsequent pregnancy, up to 5 years following baseline pregnancy
If encountered in a subsequent pregnancy, the number of cases of abnormal placentation in the cesarean scar and placenta accreta spectrum will be summarized. Ultrasound evidence of placenta accreta spectrum include disappearance of the border between placenta and myometrium, placental lacunae, increased vasculature from placenta extending into myometrium, abnormal invasion of placenta into surrounding organs and structures. Pathology will be used to confirm the number of cases of placenta accreta spectrum.
From time of enrollment to time of subsequent pregnancy, up to 5 years following baseline pregnancy
Uterine Position/Flexion
Lasso di tempo: From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
As an anteverted and retroflexed uterus is commonly the result of a cesarean delivery and scar tissue altering anatomical position, the clinicians will observe if a bladder flap alters position of the uterus. At the 6 week transvaginal ultrasound, the position of the uterus as anteverted or retroverted and flexion as anteflexed or retroflexed will be recorded. In the sagittal plane on transvaginal ultrasound, if the cervix appears on the viewer's right or left, the position is anteverted or retroverted, respectively. The anterior or posterior flexion of the fundus will define anteflexion and retroflexion, respectively
From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Number/percentage of Operative and Postoperative Complications
Lasso di tempo: From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum
Patient charts will be reviewed to summarize the number/percentage of surgical complications in each arm. This includes complications such as damage to surrounding structures, hemorrhage, hematoma formation, surgical site infections.
From enrollment to time of transvaginal ultrasound, completed approximately 6-8 weeks postpartum

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

Montefiore Medical Center

Investigatori

  • Investigatore principale: Pe'er Dar, MD, Montefiore Medical Center

Pubblicazioni e link utili

La persona responsabile dell'inserimento delle informazioni sullo studio fornisce volontariamente queste pubblicazioni. Questi possono riguardare qualsiasi cosa relativa allo studio.

Pubblicazioni generali

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio (Stimato)

1 giugno 2026

Completamento primario (Stimato)

1 giugno 2027

Completamento dello studio (Stimato)

1 maggio 2032

Date di iscrizione allo studio

Primo inviato

4 giugno 2026

Primo inviato che soddisfa i criteri di controllo qualità

4 giugno 2026

Primo Inserito (Effettivo)

9 giugno 2026

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

9 giugno 2026

Ultimo aggiornamento inviato che soddisfa i criteri QC

4 giugno 2026

Ultimo verificato

1 giugno 2026

Maggiori informazioni

Termini relativi a questo studio

Altri numeri di identificazione dello studio

  • 2025-17472

Piano per i dati dei singoli partecipanti (IPD)

Hai intenzione di condividere i dati dei singoli partecipanti (IPD)?

SÌ

Descrizione del piano IPD

De-identified individual participant data (IPD) that underlie the results reported in future publications will be made available to qualified researchers upon request

Periodo di condivisione IPD

Beginning 6 months after trial publication for a period of up to 5 years.

Criteri di accesso alla condivisione IPD

Requests will require a data use agreement and a proposal review by the study team.

Tipo di informazioni di supporto alla condivisione IPD

  • STUDIO_PROTOCOLLO
  • LINFA
  • ICF

Informazioni su farmaci e dispositivi, documenti di studio

Studia un prodotto farmaceutico regolamentato dalla FDA degli Stati Uniti

No

Studia un dispositivo regolamentato dalla FDA degli Stati Uniti

No

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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