Abstract
Discussion Forum (0)
Single-Layer Versus Double-Layer Uterine Closure at the Time of Cesarean and Subsequent Risks in Those With Placenta Accreta Spectrum
INTRODUCTION:
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Single-Layer Versus Double-Layer Uterine Closure at the Time of Cesarean and Subsequent Risks in Those With Placenta Accreta Spectrum
INTRODUCTION:
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Single-layer versus double-layer uterine closure at the time of cesarean and subsequent risks in those with placenta accreta spectrum
Rachel Harrison
Abstract
Discussion Forum (0)
Single-Layer Versus Double-Layer Uterine Closure at the Time of Cesarean and Subsequent Risks in Those With Placenta Accreta Spectrum
INTRODUCTION:
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Single-Layer Versus Double-Layer Uterine Closure at the Time of Cesarean and Subsequent Risks in Those With Placenta Accreta Spectrum
INTRODUCTION:
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
Benefits of single- versus double-layer uterine closure at the time of cesarean delivery are unclear. We sought to evaluate the effect of single- versus double-layer closure in prior cesarean delivery at the time of cesarean hysterectomy for placenta accreta spectrum (PAS).
METHODS:
Retrospective study of patients with PAS and available prior cesarean delivery operative report were included in this IRB-approved cohort study. Those with history of single-layer closure were compared to those with history of double-layer closure, and the effect on maternal outcomes at the time of cesarean hysterectomy for PAS was evaluated. The primary outcome was surgical pathology diagnosis of percreta or increta versus accreta. Secondary outcomes included blood loss, intensive care unit admission, length of stay, and surgical time. Groups were compared via chi-square, Fisher’s exact, and t tests with logistic regression to evaluate for confounders.
RESULTS:
There were 36 participants available for review, 20 of whom (55.6%) had prior single-layer closure. Those with single-layer closure had a higher number of prior cesarean deliveries (2.5±1.1 versus 1.4±0.8, P=.003); otherwise, baseline characteristics were similar between groups. Diagnosis of percreta or increta at the time of cesarean delivery was more likely among those with single-layer closure (79.9% versus 41.7%, P=.056), although not statistically significant. Blood loss, operative time, and length of stay were higher as well, but these did not reach statistical significance (approximately 3,200 versus 1,900 mL, P=.138; 167 versus 140 minutes, P=.151; 4.8 versus 3.4 days, P=.059). In the regression analysis, after controlling for the number of prior cesarean deliveries and other potential confounders, the apparent increase in diagnosis of percreta or increta did not persist (adjusted odds ratio 0.55, 95% CI 0.20–1.53).
CONCLUSION:
No statistically significant benefit to prior single- versus double-layer closure was noted at the time of cesarean hysterectomy in those with PAS.
DOI: 10.1097/01.AOG.0000930480.79036.62
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