Prior vertical uterine incision: Effect on subsequent pregnancy characteristics and outcomes

Abstract

Objective: To examine characteristics and outcomes of cesarean delivery (CD) in women with a history of vertical hysterotomy.Method: This is a comparative study that retrospectively queried the National Inpatient Sample from October 2016 to December 2018. Pregnancy characteristics and surgical outcomes of CD among 18 575 women with prior vertical uterine incision were compared to 1 072 949 women with prior low-transverse incision, assessed by multivariable generalized estimating equation model and propensity score weighting. Results:In a multivariable analysis, women who had prior vertical uterine incision were more likely to have placenta percreta (odds ratio [OR] 3.41, 95% confidence interval [CI] 1.87-6.20), pre-labor uterine rupture (OR 2.70, 95% CI 1.52-4.80), inlabor uterine rupture (OR 2.33, 95% CI 1.55-3.51), and extreme preterm delivery <28 weeks (OR 17.8,) in the current pregnancy, compared to those who had prior low-transverse uterine incision. In a weighted model, prior vertical hysterotomy was associated with increased surgical morbidity in current CD compared to prior low-transverse hysterotomy (10.6% vs. 4.8%, OR 2.02, 95% CI 1.81-2.26), including hemorrhage (OR 1.99, 95% CI 1.74-2.27) and hysterectomy (OR 3.67,. Conclusion:Prior vertical uterine incision at CD was associated with increased risk of placenta percreta, uterine rupture, particularly before labor, and adverse outcomes in the subsequent pregnancy.

Incidence of Recurrent Uterine Rupture

“…The mean number of gestational weeks at the time of recurrent uterine rupture was 32.49 (95% CI 29.90-35.08). The mean number of gestational weeks at the time of delivery without recurrent uterine rupture was 35.77 (95% CI 34.95-36.60). The maternal mortality rate was 5% (95% CI 2-11%), and the neonatal mortality rate was 5% (95% CI 3-10%).…”

“… 32 The overall incidence of uterine rupture in the subsequent pregnancy after classic cesarean delivery was estimated to range from 0.88% to 1.10%. 33 – 35 One study showed that up to 10.6% of classic cesarean deliveries resulted in uterine rupture when accompanied by labor in the next delivery. 34 The incidence of uterine rupture after myomectomy has been reported to be 0.25–0.42% after laparotomy and about 1.0% after laparoscopy.…”

Uterine rupture in the third trimester of a pregnancy subsequent to a cesarean section by transverse uterine fundal incision: A case report and literature review

“…It has been reported that pregnant women with previous cesarean section by vertical uterine incision have an increased risk of uterine rupture and preterm birth compared to pregnant women with cesarean section by transverse uterine incision. 10 In the current case, prior cesarean section was performed by transverse uterine fundal incision, which is one of the procedures for reducing blood loss during cesarean section in cases of placenta previa in which the placenta covers the anterior uterine wall. 4 There are limited reports of uterine rupture due to prior transverse uterine fundal incision.…”

The prenatal diagnostic indicators of placenta accreta spectrum disorders

“…A plausible explanation could be that changes in the structure of the uterus during labor make the tissue more adaptable to injury, and the activation of immune function also facilitates the repair of the myometrium [ [14] , [15] , [16] , [17] ]. Interestingly, prior vertical uterine incision also increases the incidence of PAS in the second pregnancy, especially placenta percreta and uterine rupture [ 18 ]. More research is required to better understand the etiology of the association between vertical hysterotomy and placenta implantation.…”