The vesicouterine fold is the peritoneal reflection between the anterior surface of the uterus and the posterior surface of the bladder, forming the vesicouterine pouch (anterior cul-de-sac). In its lower portion, the peritoneum invests the uterovesical space above the attachment of the bladder to the lower uterine segment, and below the fold the bladder and uterine cervix are separated only by loose areolar tissue.
Marks the peritoneal fold that must be opened to access the uterovesical space for lower segment caesarean section bladder flap development and for hysterectomy anterior dissection.
The vesicouterine fold is the starting point for lower segment caesarean section: the fold is identified, incised, and the bladder reflected inferiorly as a bladder flap before the lower uterine segment is incised. Adhesions in the vesicouterine fold from previous caesarean sections (bladder can become adherent to the lower segment scar) make repeat caesarean technically more difficult and risk bladder injury. Placenta praevia accreta (morbid adherence) at the lower segment may involve the vesicouterine fold structures.
Adhesions between the bladder and the uterine lower segment at the vesicouterine fold from previous caesarean section scars make bladder reflection difficult during repeat surgery, with risk of inadvertent cystotomy if the bladder is sharply dissected from the adherent scar; identified intraoperatively by blue dye and repaired primarily in layers.
