title: 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).
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Eleven tertiary referral hospitals in central Japan.
  
  
  METHODS
  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).
  
  
  METHODS
  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.affiliation: Department of Obstetrics and Gynaecology, Nagoya University Graduate School of Medicine, Aichi, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Sumigama
authors.forename: C
authors.initials: C
authors.lastname: Sugiyama
authors.forename: T
authors.initials: T
authors.lastname: Kotani
authors.forename: H
authors.initials: H
authors.lastname: Hayakawa
authors.forename: A
authors.initials: A
authors.lastname: Inoue
authors.forename: Y
authors.initials: Y
authors.lastname: Mano
authors.forename: H
authors.initials: H
authors.lastname: Tsuda
authors.forename: M
authors.initials: M
authors.lastname: Furuhashi
authors.forename: O
authors.initials: O
authors.lastname: Yamamuro
authors.forename: Y
authors.initials: Y
authors.lastname: Kinoshita
authors.forename: T
authors.initials: T
authors.lastname: Okamoto
authors.forename: H
authors.initials: H
authors.lastname: Nakamura
authors.forename: K
authors.initials: K
authors.lastname: Matsusawa
authors.forename: K
authors.initials: K
authors.lastname: Sakakibara
authors.forename: H
authors.initials: H
authors.lastname: Oguchi
authors.forename: M
authors.initials: M
authors.lastname: Kawai
authors.forename: Y
authors.initials: Y
authors.lastname: Shimoyama
authors.forename: K
authors.initials: K
authors.lastname: Tamakoshi
authors.forename: F
authors.initials: F
authors.lastname: Kikkawa
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D010921:Placenta Accreta / Q000453:epidemiology* / Q000209:etiology*; D010923:Placenta Previa; D011247:Pregnancy; D012189:Retrospective Studies; D013536:Suture Techniques / Q000009:adverse effects*; D014599:Uterus / Q000601:surgery*
keywords: Caesarean section; GRADE; continuous suture; interrupted suture; placenta accreta; uterine closure