INTRODUCTION:
Uterine closure technique at time of cesarean section has been extensively studied with regard to risk of operative bleeding, infectious morbidity, development of wedge defects, and risk of uterine rupture in subsequent pregnancy. Only one study has evaluated subsequent risk of abnormally-invasive placentation (AIP). We seek to describe AIP risk based on hysterotomy closure characteristics at the time of prior cesarean delivery.
METHODS:
A review of participants delivered at a single, large, tertiary care center from 12/15/2011-08/22/2017 was performed. Records were reviewed and data was abstracted pertaining to demographics, pregnancy characteristics, obstetric history, suture use, and tissue pathology. Data was summarized using SAS software, version 9.4.
RESULTS:
Of the 169 cases of AIP, 154 (91.1%) had a history of cesarean section. Information detailing prior hysterotomy closure was available for 48 (31.2%) patients, 9 (39.6%) with single-layer closure and 29 (60.4%) were closed in two layers. There was a statistically-significant difference observed in incidence of AIP among patients with double-layer closures (93.1% vs 41.4%, p 0.035). Closures were performed with Vicryl (n = 32, 20.8%), Monocryl (n = 5, 3.2%), PDS (n = 6, 3.9%), and chromic (n = 4, 2.6%) suture. The incidence of AIP for each group was 81.3%, 100%, 83.3%, and 50%, respectively (p 0.97). Larger suture caliber was associated with an increased incidence of AIP (p 0.032).
CONCLUSION:
Our data suggests that risk of AIP may be influenced by double- vs single-layer hysterotomy closure. Future large, randomized trials are warranted to adequately assess this relationship.