Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA.
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
J Matern Fetal Neonatal Med. 2021 Aug;34(15):2513-2521. doi: 10.1080/14767058.2019.1670158. Epub 2019 Oct 3.
Abnormal placentation can result in massive hemorrhage, which is the leading cause of severe maternal morbidities and mortality in its management. Over the past 50 years, the incidence of placenta previa (PP), abnormal implantation of the placenta, and cesarean scar pregnancy have continued to rise. This coincides with the well-documented parallel rise in the rate of cesarean deliveries, the performance of multiple repeat cesarean deliveries and the adoption of newer uterine closure techniques. However, no studies have examined the role of uterine closure techniques in abnormal placentation in women with a history of a prior cesarean delivery.
To assess the practicality of one specific uterine closure technique at cesarean delivery and to evaluate the relationship between previous cesarean delivery and subsequent development of abnormal implantation of the placenta, as well as neonatal and other perioperative outcomes after receiving an endometrium-free uterine closure technique.
This retrospective observational study considered cesarean deliveries ( = 727) and subsequent vaginal births after cesarean delivery ( = 109) among total deliveries ( = 4496) performed in private practice at NYU Langone Health from 1985 to 2015. All cesarean deliveries were performed using the endometrium-free uterine closure technique. The primary outcome was the incidence of abnormal implantation of the placenta in subsequent pregnancies. The secondary outcomes were neonatal and maternal complications, specifically postoperative hemoglobin and hematocrit concentration losses. The association between independent variables and outcomes were evaluated using mixed-effect regression models.
In contrast to published data, independent of the number of repeat cesarean deliveries, the presence of 26 (3.1%) PPs and of 366 (43.8%) anterior placentas, there were no patients with abnormal implantation of the placenta in a cesarean scar, neither prenatally nor at delivery. Maternal hemorrhage, postoperative and neonatal complications did not reach clinical significance. The statistical analysis revealed that, when compared with women who had fewer repeat cesarean deliveries using endometrium-free uterine closure technique, those with the most had a lesser risk of forming PP and less blood loss, as measured by both hematocrit and hemoglobin evaluation.
In this retrospective cohort study, the exclusion of the endometrium during the endometrium-free uterine closure technique was associated with fewer placental abnormalities in subsequent pregnancies and reduced life-threatening maternal morbidity for future cesarean deliveries.
异常胎盘会导致大量出血，这是导致严重产妇发病率和死亡率的主要原因。在过去的 50 年中，前置胎盘（PP）、胎盘异常植入和剖宫产瘢痕妊娠的发病率持续上升。这与剖宫产率的有记录的平行上升、多次重复剖宫产和采用新的子宫闭合技术相一致。然而，尚无研究探讨在有剖宫产史的妇女中，子宫闭合技术在异常胎盘中的作用。
评估剖宫产时使用一种特定子宫闭合技术的实用性，并评估既往剖宫产与随后胎盘异常植入的发展以及接受无子宫内膜子宫闭合技术后的新生儿和其他围手术期结局之间的关系。
本回顾性观察性研究考虑了 1985 年至 2015 年在纽约大学朗格尼健康私人执业期间进行的总分娩（共 4496 例）中的剖宫产分娩（727 例）和随后的剖宫产分娩后阴道分娩（109 例）。所有剖宫产均采用无子宫内膜子宫闭合技术。主要结局是后续妊娠中异常胎盘植入的发生率。次要结局是新生儿和产妇并发症，特别是术后血红蛋白和血细胞比容浓度损失。使用混合效应回归模型评估独立变量与结局之间的关系。
与已发表的数据相反，无论重复剖宫产的次数如何，26 例（3.1%）前置胎盘和 366 例（43.8%）前胎盘的存在，均无剖宫产瘢痕异常植入的患者，无论是产前还是分娩时。母体出血、术后和新生儿并发症未达到临床意义。统计分析显示，与使用无子宫内膜子宫闭合技术的重复剖宫产次数较少的女性相比，重复剖宫产次数最多的女性发生前置胎盘和失血较少的风险较低，通过血细胞比容和血红蛋白评估均可体现。
在这项回顾性队列研究中，在无子宫内膜子宫闭合技术中排除子宫内膜与随后妊娠中的胎盘异常形成减少以及未来剖宫产的危及生命的产妇发病率降低有关。
