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Shibata T, Nishijima K, Nakago S, Kotsuji F. Updated criteria for the approval of subsequent pregnancy after cesarean section with a transverse uterine fundal incision based on 17 years of experience. J Obstet Gynaecol Res 2024. [PMID: 39073199 DOI: 10.1111/jog.16015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 06/18/2024] [Indexed: 07/30/2024]
Abstract
In the case of placenta previa-accreta when the placenta covers the entire anterior uterine wall, it is difficult to avoid transecting the placenta by traditional low-transverse cesarean section (CS), resulting in catastrophic hemorrhage and fetal anemia. To prevent this critical risk, we developed the CS with transverse uterine fundal incision (TUFI) and this technique has been widely used as a beneficial surgical method in clinical practice owing to its safety advantages for the mother and neonate since our first report. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. Based on our 17 years of experience, patients who require TUFI do not need to avoid this beneficial operative method simply because of their desire to conceive again, as long as certain conditions can be met. To approve a post-TUFI pregnancy, an appropriate suture method, delay in conception for at least 12 months with evaluation of the TUFI scar, and cautious postoperative management are at a minimum essential. In this article, we showed our recommendation for operative procedure and discuss the current status of the management of post-TUFI pregnancies based on the evaluation of the TUFI wound scar and experience with postoperative pregnancies.
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Affiliation(s)
- Takashi Shibata
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Koji Nishijima
- General Center for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Satoshi Nakago
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
| | - Fumikazu Kotsuji
- Department of Obstetrics and Gynecology, Takatsuki General Hospital, Takatsuki, Japan
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Choi MJ, Lim CM, Jeong D, Jeon HR, Cho KJ, Kim SY. Efficacy of intraoperative wireless ultrasonography for uterine incision among patients with adherence findings in placenta previa. J Obstet Gynaecol Res 2020; 46:876-882. [PMID: 32207196 DOI: 10.1111/jog.14243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 02/22/2020] [Accepted: 03/07/2020] [Indexed: 12/01/2022]
Abstract
AIM We evaluated the effectiveness of intraoperative wireless ultrasonography in determining the location of uterine incision during cesarean delivery in patients with placenta previa who have sonographic adherence findings in order to assess intraoperative blood loss and maternal morbidity. METHODS A prospective study using wireless sonography, including 15 patients with previa, was conducted among women with singleton pregnancies who delivered by cesarean section between August 1, 2017, and August 30, 2019. Retrospective study for the control group included 32 patients with placenta previa who underwent cesarean section between January 1, 2016, and July 31, 2017, without wireless sonography. Patients with previa who had adherence findings in prenatal sonography were included in both groups. Logistic regression was used to identify the association between massive intraoperative bleeding loss and use of wireless ultrasound sonography. RESULTS Intraoperative blood loss was significantly reduced in the study group compared to that in the control group (P = 0.009). The hospital stay was significantly shorter in the study group compared to the control group (5 days vs 6 days, P < 0.001). The use of intraoperative wireless sonography (P = 0.01) had a significant association with massive intraoperative hemorrhage in multivariable analysis. CONCLUSION Our study is the first study to apply a wireless ultrasound sonography device in women with placenta previa during cesarean section to examine maternal morbidity. This latest wireless ultrasound sonography device is advantageous for uterine incision guidance in women with placenta previa and improves maternal morbidity by reducing intraoperative hemorrhage.
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Affiliation(s)
- Min J Choi
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chan M Lim
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dahoe Jeong
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Hae-Rin Jeon
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kyung J Cho
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Suk Y Kim
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
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Peng X, Chen D, Xu J, Liu X, You Y, Peng B. Parallel transverse uterine incisions, a novel approach for managing heavy hemorrhage and preserving the uterus: A retrospective cohort study for patients with anterior placenta previa and accreta. Medicine (Baltimore) 2019; 98:e17742. [PMID: 31689824 PMCID: PMC6946211 DOI: 10.1097/md.0000000000017742] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 08/16/2019] [Accepted: 10/01/2019] [Indexed: 11/26/2022] Open
Abstract
Placenta previa and accreta with prior cesarean section is an extremely serious condition that is associated with maternal morbidity and mortality from obstetric hemorrhage. The aim of our study was to evaluate the efficacy and advantages of a novel surgical technique, parallel transverse uterine incisions (PTUI), during conservative cesarean delivery in patients with placenta previa and accreta.This was a retrospective cohort study including 124 pregnant women, who had at least 1 prior cesarean section and were diagnosed with anterior placenta previa and accreta between January 2014 and October 2017. Using the hospital's information system, patients were retrospectively classified into undergoing either the PTUI surgery (Group A) or the ordinary cesarean section (Group B). Surgical outcomes and maternal complications during hospitalization were collected. The results from 2 groups were compared and analyzed statistically. Multivariable regression analyses were further used to assess the effect of PTUI on severe maternal outcomes.Patients who underwent PTUI were not statistically different from patients who underwent the ordinary cesarean section in terms of maternal and infants' characteristics. However, PTUI was associated with remarkably reduced intraoperative blood loss (P = .005), related vaginal blood loss after surgery (P = .026), and transfusion requirement of packed red cells (P = .000), compared to the ordinary cesarean section. Moreover, cesarean hysterectomy (3.3% vs 21.9%; P = .002) and intensive care unit admission (1.7% vs 29.7%; P = .000) were significantly fewer among patients who underwent PTUI. Multivariable regression analyses further showed that the risk of intraoperative hemorrhage (β = -2343.299, P = .000) and cesarean hysterectomy (odds ratio = 0.027, P = .018) were both significantly decreased by PTUI.PTUI is a novel approach that may significantly reduce maternal complications, while preserving the uterus for patients with anterior placenta previa and accreta.
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Affiliation(s)
- Xue Peng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Daijuan Chen
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Jinfeng Xu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Xinghui Liu
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Yong You
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Bing Peng
- Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
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Boekhoff J, Arabin B, Figiel J, Köhler S. "Leaving the placenta in situ approach" (LISA) in a patient with placenta increta leading to delayed spontaneous delivery of the placenta. J Matern Fetal Neonatal Med 2018; 33:341-343. [PMID: 30012037 DOI: 10.1080/14767058.2018.1488960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Aim: Based on the recent FIGO recommendations, we wish to report on preservation of the uterus in a patient with placenta increta by applying the leaving the placenta in situ approach.Methods: A 30-year-old gravida 2, Para 1 was referred at 25 + 5 gestational weeks due to a placenta previa bipartita increta diagnosed by transvaginal ultrasound, a history of a cesarean and vaginal bleeding. After informed consent, the parents opted for conservative treatment. The patient was admitted and the options of treatment were communicated within a multidisciplinary team. At 31 + 4 gestational weeks, severe recurrent hemorrhage led to a repeat cesarean.Results: A boy of 1910 g was delivered and the placenta was left in situ. Estimated blood loss was <200 ml. An MRI on day 13 still showed regular placental circulation, but after 4 weeks, perfusion and HCG levels had significantly decreased. The patient was examined every 3 days and readmitted after 6 weeks with a sudden rise of d-dimers. Within 24 hours, the complete placenta was delivered. On postoperative day 54, MRI confirmed uterine involution without a placental tissue.Conclusions: Delayed placental delivery in patients with abnormal placental invasion is a legitimate option to preserve fertility and possibly to reduce intrapartum hemorrhage.
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Affiliation(s)
- Jelena Boekhoff
- Center for Mother and Child, Philipps University, Marburg, Germany
| | - Birgit Arabin
- Center for Mother and Child, Philipps University, Marburg, Germany.,Clara Angela Foundation Witten, Berlin, Germany
| | - Jens Figiel
- Department of Radiology, Philipps University, Marburg, Germany
| | - Siegmund Köhler
- Center for Mother and Child, Philipps University, Marburg, Germany
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Ishida H, Takashima A, Nagaoka M, Takeshita N, Kinoshita T. Uterine rupture due to placenta percreta in the first trimester of a pregnancy subsequent to a transverse uterine fundal cesarean section: A case report. J Obstet Gynaecol Res 2018; 44:1832-1835. [PMID: 29974567 DOI: 10.1111/jog.13699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 05/20/2018] [Indexed: 11/27/2022]
Abstract
Transverse uterine fundal cesarean section in cases of total placenta previa reduces blood loss, but its influence on subsequent pregnancies, including the uterine rupture risk, remains unclear. We report a case of uterine rupture due to placenta percreta in the first trimester in a 43-year-old woman who underwent transverse uterine fundal incision in a previous pregnancy (at 40 years old). The patient did not undergo assessment of the uterine scare after the previous operation. Oocyte donation and in vitro fertilization at another institution resulted in the current pregnancy. At 11 weeks 3 days, she was admitted to the emergency department because of sudden severe abdominal pain. Ultrasound showed massive accumulation of free fluid in the peritoneal cavity and the fetus was outside the uterine cavity; uterine rupture was diagnosed. During emergency laparotomy, the uterine rupture was detected at exactly the previous incision site; a total hysterectomy was performed. Pregnancy after a transverse uterine fundal cesarean section is at high risk. As uterine scar dehiscence might have caused the uterine rupture, wounds should be evaluated before allowing subsequent pregnancies.
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Affiliation(s)
- Hiroaki Ishida
- Department of Obstetrics and Gynecology, Toho University Medical Center-Sakura Hospital, Chiba, Japan
| | - Akiko Takashima
- Department of Obstetrics and Gynecology, Toho University Medical Center-Sakura Hospital, Chiba, Japan
| | - Masahiro Nagaoka
- Department of Obstetrics and Gynecology, Toho University Medical Center-Sakura Hospital, Chiba, Japan
| | - Naoki Takeshita
- Department of Obstetrics and Gynecology, Toho University Medical Center-Sakura Hospital, Chiba, Japan
| | - Toshihiko Kinoshita
- Department of Obstetrics and Gynecology, Toho University Medical Center-Sakura Hospital, Chiba, Japan
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You Y, Fu J, Chen H, Luo L, Liu X, Peng B. Parallel transverse uterine incisions to control postpartum hemorrhage and preserve fertility during cesarean delivery for placenta previa and accreta. Int J Gynaecol Obstet 2016; 134:221-2. [DOI: 10.1016/j.ijgo.2016.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/14/2016] [Accepted: 04/25/2016] [Indexed: 10/21/2022]
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Morikawa M, Kuramoto A, Nakayama M, Oguchi H, Hasegawa M, Funakoshi T, Furukawa S, Hirayama E, Kanagawa T, Kaji T, Kasai M, Konishi Y, Yamamoto SI, Itakura A, Maeda M, Kobayashi T, Minakami H. Intraoperative red cell salvage during obstetric surgery in 50 Japanese women. Int J Gynaecol Obstet 2014; 128:256-9. [DOI: 10.1016/j.ijgo.2014.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/25/2014] [Accepted: 10/20/2014] [Indexed: 11/28/2022]
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Placenta percreta with a vaginal fistula after successful management by uterine transverse fundal incision and subsequent cesarean hysterectomy. Obstet Gynecol Sci 2014; 57:397-400. [PMID: 25264531 PMCID: PMC4175601 DOI: 10.5468/ogs.2014.57.5.397] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/12/2014] [Accepted: 05/15/2014] [Indexed: 11/08/2022] Open
Abstract
Placenta previa presents a highest risk to pregnancy, and placenta accreta is the most serious. Placenta accreta requires cesarean delivery and often results in massive obstetric hemorrhage and higher maternal morbidity. Challenges associated with cesarean delivery techniques may contribute to increased maternal blood loss and morbidity rates. Several recent obstetric studies reported the usefulness of transverse uterine fundal incision for managing placenta accreta. We present a case of placenta percreta that was treated by a transverse fundal incision. We successfully avoided cutting through the placenta and helped decrease maternal blood loss. After delivery, the patient underwent a cesarean hysterectomy. Postoperative day 48, she experienced watery discharge and was diagnosed with vaginal fistula. We present our case and review the literature.
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Verspyck E, Douysset X, Roman H, Marret S, Marpeau L. Transecting versus avoiding incision of the anterior placenta previa during cesarean delivery. Int J Gynaecol Obstet 2014; 128:44-7. [DOI: 10.1016/j.ijgo.2014.07.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 06/29/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
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Nishida R, Morikawa M, Yamada T, Takeda M, Akaishi R, Cho K, Minakami H. Successful pregnancy in a woman with uterine scarring by transverse fundal cesarean section. J Obstet Gynaecol Res 2014; 40:1420-2. [DOI: 10.1111/jog.12361] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 11/16/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Ryutaro Nishida
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Mamoru Morikawa
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Takahiro Yamada
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Masamitsu Takeda
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Rina Akaishi
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Kazutoshi Cho
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
| | - Hisanori Minakami
- Center for Perinatal Medicine; Hokkaido University Hospital; Sapporo Japan
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Nishida R, Yamada T, Yamada T, Morikawa M, Kawaguchi S, Minakami H. Viable delivery after conservative management of a cesarean scar pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:1682-1684. [PMID: 23980234 DOI: 10.7863/ultra.32.9.1682] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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