Usefulness of transverse fundal incision method of cesarean section for women with placentas widely covering the entire anterior uterine wall.
OBJECTIVE
To assess the usefulness of a new method for cesarean section (CS) that is comprised of a transverse incision into the uterine fundus, developed for women with placentas covering the entire anterior uterine wall, and introduced in September 2006.


METHODS
Review of medical records of 12 and 29 women who underwent CS by the new and conventional methods, respectively, for placenta previa, placenta accreta (accreta, increta and percreta) or placenta widely covering the entire anterior uterine wall in which placenta accreta cannot be excluded, between June 2003 and March 2011.


RESULTS
Placenta accreta (67% [8/12] vs 10% [3/29], P=0.0006) and cesarean hysterectomy (67% vs 10%) were significantly more frequent in the group with the new compared with the conventional method. There were no significant differences between groups with the new and conventional methods in amount of blood loss (1732±1067 vs 1847±1279g, respectively), prevalence of blood loss >3000g (8.3% vs 17%, respectively) or blood transfusion (92% vs 72%, respectively), time required for cesarean hysterectomy (210±58 vs 195±41min), or neonatal conditions at birth. The amount of blood loss for cesarean hysterectomy was significantly less for the new than conventional method (1959±1025g vs 4450±1145g, P=0.041).


CONCLUSIONS
The new method was superior to the conventional method with respect to reduction of blood loss during cesarean hysterectomy. However, careful observations are mandatory in women with preserved uterus with respect to a possible increased risk of uterine rupture in future pregnancies.
Department of Obstetrics, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Ryutaro
R
Nishida
Takahiro
T
Yamada
Rina
R
Akaishi
Takashi
T
Kojima
Satoshi
S
Ishikawa
Masamitsu
M
Takeda
Mamoru
M
Morikawa
Takashi
T
Yamada
Hisanori
H
Minakami
D002585:Cesarean Section / Q000379:methods*; D005260:Female; D006801:Humans; D010920:Placenta / Q000000981:diagnostic imaging / Q000601:surgery*; D010922:Placenta Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D011247:Pregnancy; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal; D014599:Uterus / Q000000981:diagnostic imaging / Q000601:surgery*