Bladder flap creation during cesarean delivery. A systematic review and meta-analysis of randomized controlled trials

Abstract Background The aim of the study is to compare the risks and benefits of bladder flap creation and omission during cesarean delivery. Methods The databases search from inception to August 2025 included PubMed, Scopus, Embase, Web Of Science, Cochrane library, and clinicaltrials.gov registration using the keywords cesarean delivery AND bladder flap and their MesH terms yielded 13 studies with 3663 participants. All studies were evaluated through risk of bias assessment, and the quality of evidence was assessed through GRADE analysis. Results Microscopic hematuria was evaluated in 6 studies with 2738 participants and revealed an Odds Ratio (OR) of 3.23 with 1.10, 9.42 95% Confidence Interval (CI), P value = 0.04, I2 = 94%. Intraoperative blood loss was evaluated in 3 studies with 609 participants and revealed a mean difference (MD) of 46.75 with -123.50, 217.00 95% Confidence Interval (CI), P value =0.59, I2 =89%. Hemoglobin drop was evaluated in 7 studies with 2953 participants and revealed a MD of 0.15 with -0.05, 0.35 95% Confidence Interval (CI), P value =0.13, I2 =99%. Total operative time was evaluated in 9 studies with 3170 participants and revealed a MD of 7.93 minutes with 3.21, 12.66 95% Confidence Interval (CI), P value =0.001, I2 =97%. Incision to delivery time was evaluated in 8 studies with 3131 participants and revealed a MD of 0.52 minutes with 0.45, 0.58 95% Confidence Interval (CI), P value