Uterine sutures at prior caesarean section and placenta accreta in subsequent pregnancy: a case–control study. (26th March 2014)

• Record Type: Journal Article
• Authors: Sumigama, S; Sugiyama, C; Kotani, T; Hayakawa, H; Inoue, A; Mano, Y; Tsuda, H; Furuhashi, M; Yamamuro, O; Kinoshita, Y; Okamoto, T; Nakamura, H; Matsusawa, K; Sakakibara, K; Oguchi, H; Kawai, M; Shimoyama, Y; Tamakoshi, K; Kikkawa, F
• Is Part Of: BJOG. Volume 121:Number 7(2014:Jul.)
• Page Start: 866
• Page End: 875
• Publication Date: 2014-03-26
• Subjects: Obstetrics -- Periodicals; Gynecology -- Periodicals; 618
• DOI: 10.1111/1471-0528.12717
• Languages: English
• ISSNs: 1470-0328

Abstract

<abstract abstract-type="main" id="bjo12717-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="bjo12717-sec-0001" sec-type="section"> <title>Objective</title> <p>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).</p> </sec> <sec id="bjo12717-sec-0002" sec-type="section"> <title>Design</title> <p>Case–control study.</p> </sec> <sec id="bjo12717-sec-0003" sec-type="section"> <title>Setting</title> <p>Eleven tertiary referral hospitals in central Japan.</p> </sec> <sec id="bjo12717-sec-0004" sec-type="section"> <title>Population</title> <p>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.</p> </sec> <sec id="bjo12717-sec-0005" sec-type="section"> <title>Methods</title> <p>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).</p> </sec> <sec id="bjo12717-sec-0006" sec-type="section"> <title>Main outcome measure</title> <p>The incidence of placenta accreta.</p> </sec> <sec id="bjo12717-sec-0007" sec-type="section"> <title>Results</title> <p>No difference was found comparing single‐layer with double‐layer closure in the incidence of placenta accreta (37.1 versus 39.7%, <italic>P</italic> = 0.805); however, a significant difference was found comparing continuous with interrupted sutures (58.1 versus 29.9%, <italic>P</italic> = 0.008). Multivariable logistic regression analysis with stepwise selection for the eight factors meeting the criterion of <italic>P</italic> < 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, <italic>P</italic> = 0.050); total praevia (versus non‐total, aOR 18.4, 95% CI 3.2–107.0, <italic>P</italic> = 0.001); anterior/centre placenta (versus posterior, aOR 16.4, 95% CI 3.7–72.2, <italic>P</italic> < 0.001); and continuous sutures (versus interrupted, aOR 6.0, 95% CI 1.4–25.2, <italic>P</italic> = 0.015).</p> </sec> <sec id="bjo12717-sec-0008" sec-type="section"> <title>Conclusions</title> <p>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.</p> </sec> </abstract>