Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy: a case-control study.

Abstract

OBJECTIVE:

To clarify the effects of uterine myometrial suture techniques at prior caesarean section on the incidence of pathologically diagnosed placenta accreta in placenta praevia with prior caesarean section (PPPC).

DESIGN:

Case-control study.

SETTING:

Eleven tertiary referral hospitals in central Japan.

POPULATION:

A total of 98 cases of placenta praevia, a history of one or more prior caesarean sections, and a history of uterine transverse incision and usage of only absorbable thread for myometrial sutures at the prior caesarean section. Exclusions were a history of myomectomy or Strassmann's operation.

METHODS:

Cases were grouped into a pathologically diagnosed placenta accreta group (38 cases) and a no accreta group (60 cases). Clinical characteristics including uterine suture methods at prior caesarean section were compared (single-layer versus double-layer closure; continuous versus interrupted sutures in the inner myometrial layer).

MAIN OUTCOME MEASURE:

The incidence of placenta accreta.

RESULTS:

No difference was found comparing single-layer with double-layer closure in the incidence of placenta accreta (37.1 versus 39.7%, P = 0.805); however, a significant difference was found comparing continuous with interrupted sutures (58.1 versus 29.9%, P = 0.008). Multivariable logistic regression analysis with stepwise selection for the eight factors meeting the criterion of P < 0.10 in univariate analysis was used, and four independent factors were selected, as follows: gravidity ≥ 3 (adjusted odds ratio, aOR, 3.4, 95% confidence interval, 95% CI, 0.99-11.6, P = 0.050); total praevia (versus non-total, aOR 18.4, 95% CI 3.2-107.0, P = 0.001); anterior/centre placenta (versus posterior, aOR 16.4, 95% CI 3.7-72.2, P < 0.001); and continuous sutures (versus interrupted, aOR 6.0, 95% CI 1.4-25.2, P = 0.015).

CONCLUSIONS:

In this limited study, a history of continuous sutures on the inner side of the uterine wall showed potential to influence the development of placenta accreta in PPPC patients.

• Authors: S Sumigama, C Sugiyama, T Kotani, H Hayakawa, A Inoue, Y Mano, H Tsuda, M Furuhashi, O Yamamuro, Y Kinoshita, T Okamoto, H Nakamura, K Matsusawa, K Sakakibara, H Oguchi, M Kawai, Y Shimoyama, K Tamakoshi, F Kikkawa
• Journal: BJOG : an international journal of obstetrics and gynaecology (BJOG) Vol. 121 Issue 7 Pg. 866-74; discussion 875 (Jun 2014) ISSN: 1471-0528 [Electronic] England
• PMID: 24666658 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 Royal College of Obstetricians and Gynaecologists.

Topics

• Adult
• Case-Control Studies
• Cesarean Section (adverse effects, methods)
• Female
• Humans
• Incidence
• Placenta Accreta (epidemiology, etiology)
• Placenta Previa
• Pregnancy
• Retrospective Studies
• Suture Techniques (adverse effects)
• Uterus (surgery)