Comparison of transverse versus midline abdominal incision at cesarean delivery for placenta accreta spectrum: a multicenter study
Year: 2025
Type: preprint
Study design: Observational Study
Abstract: Objective: To compare maternal peri- and postoperative outcomes by abdominal incision type in patients with prenatal suspicion of placenta accreta spectrum (PAS). Design: Multicenter retrospective cohort. Setting: Four academic centers in New York City from 2013-2022. Population: Patients with antenatally suspected and histopathological confirmed PAS, stratified by abdominal incision type (transverse or midline). Methods: We compared findings between transverse and midline incision groups using multivariable logistic regression, adjusting for age, body mass index, prior cesareans, placenta location, and invasion level. Main Outcome Measures: Markers of severe maternal morbidity including massive transfusion, intubation with mechanical ventilation, intraabdominal surgical injury and intensive care unit admission. Secondary outcomes were hemorrhage, blood transfusion, operative time, postoperative stay, re-operation necessity, and mortality. Results: 212 pregnancies were included: 76 (36%) transverse and 136 (64%) midline incision. Demographic risk factors for midline incision were obesity (63% vs 49%, p=0.04) and percreta (34% vs 16%, p=0.03). No differences observed in unplanned delivery, delivery location and gynecologic oncology involvement between groups. Primary composite morbidity outcome was increased in those with midline incision (aOR 4.52, 95%CI 1.88-10.88, p<0.01). Additionally, midline incision was associated with increased hemorrhage (aOR 2.95, 95%CI 1.25-6.96, p<0.01), massive transfusion (aOR 2.59, 95%CI 1.17-5.71, p=0.01), and longer operative time (201.5 ± 12.7 vs 174.9 ± 22.6mins, p<0.01) and post-operative stay (7.6 ± 1.2 vs 5.3 ± 0.9days, p=0.03). Conclusion: Midline abdominal incision was associated with increased severe maternal morbidity, and longer operative time and postoperative hospital stay. Findings provide valuable data when considering choice of abdominal incision for PAS cases.
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: gold
OpenAlex ID: W4415188958
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