These authors contributed equally.
Usefulness of transverse fundal incision method of cesarean section for women with placentas widely covering the entire anterior uterine wall
Article first published online: 13 JUN 2012
© 2012 The Authors. Journal of Obstetrics and Gynaecology Research © 2012 Japan Society of Obstetrics and Gynecology
Journal of Obstetrics and Gynaecology Research
Volume 39, Issue 1, pages 91–95, January 2013
How to Cite
Nishida, R., Yamada, T., Akaishi, R., Kojima, T., Ishikawa, S., Takeda, M., Morikawa, M., Yamada, T. and Minakami, H. (2013), Usefulness of transverse fundal incision method of cesarean section for women with placentas widely covering the entire anterior uterine wall. Journal of Obstetrics and Gynaecology Research, 39: 91–95. doi: 10.1111/j.1447-0756.2012.01921.x
- Issue published online: 7 JAN 2013
- Article first published online: 13 JUN 2012
- Received: November 30 2011.; Accepted: March 21 2012.
- cesarean hysterectomy;
- placenta accrete;
- placenta previa;
- postpartum hemorrhage
Aim: 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.
Material and 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 ± 1279 g, respectively), prevalence of blood loss >3000 g (8.3% vs 17%, respectively) or blood transfusion (92% vs 72%, respectively), time required for cesarean hysterectomy (210 ± 58 vs 195 ± 41 min), or neonatal conditions at birth. The amount of blood loss for cesarean hysterectomy was significantly less for the new than conventional method (1959 ± 1025 g vs 4450 ± 1145 g, P = 0.041).
Conclusion: 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.