Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment

Cynthia Gyamfi-Bannerman; Sharon Gilbert; Mark B. Landon; Catherine Y. Spong; Dwight J. Rouse; Michael W. Varner; Steve N. Caritis; Paul J. Meis; Ronald J. Wapner; Yoram Sorokin; Marshall Carpenter; Alan M. Peaceman; Mary J. O'Sullivan; Baha M. Sibai; John M. Thorp; Susan M. Ramin; Brian M. Mercer

doi:10.1097/AOG.0b013e318273695b

Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment

Cynthia Gyamfi-Bannerman, Sharon Gilbert, Mark B. Landon, Catherine Y. Spong, Dwight J. Rouse, Michael W. Varner, Steve N. Caritis, Paul J. Meis, Ronald J. Wapner, Yoram Sorokin, Marshall Carpenter, Alan M. Peaceman, Mary J. O'Sullivan, Baha M. Sibai, John M. Thorp, Susan M. Ramin, Brian M. Mercer

Research output: Contribution to journal › Article › peer-review

89 Scopus citations

Abstract

OBJECTIVE: Women with a prior myomectomy or prior classical cesarean delivery often have early delivery by cesarean because of concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well-quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. METHODS: Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery to estimate rates of both uterine rupture and placenta accreta. RESULTS: One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group (P>.99). CONCLUSION: A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low.

Original language	English (US)
Pages (from-to)	1332-1337
Number of pages	6
Journal	Obstetrics and gynecology
Volume	120
Issue number	6
DOIs	https://doi.org/10.1097/AOG.0b013e318273695b
State	Published - Dec 2012
Externally published	Yes

ASJC Scopus subject areas

Obstetrics and Gynecology

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10.1097/AOG.0b013e318273695b

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Gyamfi-Bannerman, C., Gilbert, S., Landon, M. B., Spong, C. Y., Rouse, D. J., Varner, M. W., Caritis, S. N., Meis, P. J., Wapner, R. J., Sorokin, Y., Carpenter, M., Peaceman, A. M., O'Sullivan, M. J., Sibai, B. M., Thorp, J. M., Ramin, S. M., & Mercer, B. M. (2012). Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment. Obstetrics and gynecology, 120(6), 1332-1337. https://doi.org/10.1097/AOG.0b013e318273695b

Gyamfi-Bannerman, C, Gilbert, S, Landon, MB, Spong, CY, Rouse, DJ, Varner, MW, Caritis, SN, Meis, PJ, Wapner, RJ, Sorokin, Y, Carpenter, M, Peaceman, AM, O'Sullivan, MJ, Sibai, BM, Thorp, JM, Ramin, SM & Mercer, BM 2012, 'Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment', Obstetrics and gynecology, vol. 120, no. 6, pp. 1332-1337. https://doi.org/10.1097/AOG.0b013e318273695b

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title = "Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment",

abstract = "OBJECTIVE: Women with a prior myomectomy or prior classical cesarean delivery often have early delivery by cesarean because of concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well-quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. METHODS: Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery to estimate rates of both uterine rupture and placenta accreta. RESULTS: One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group (P>.99). CONCLUSION: A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low.",

author = "Cynthia Gyamfi-Bannerman and Sharon Gilbert and Landon, {Mark B.} and Spong, {Catherine Y.} and Rouse, {Dwight J.} and Varner, {Michael W.} and Caritis, {Steve N.} and Meis, {Paul J.} and Wapner, {Ronald J.} and Yoram Sorokin and Marshall Carpenter and Peaceman, {Alan M.} and O'Sullivan, {Mary J.} and Sibai, {Baha M.} and Thorp, {John M.} and Ramin, {Susan M.} and Mercer, {Brian M.}",

year = "2012",

month = dec,

doi = "10.1097/AOG.0b013e318273695b",

language = "English (US)",

volume = "120",

pages = "1332--1337",

journal = "Obstetrics and gynecology",

issn = "0029-7844",

publisher = "Lippincott Williams and Wilkins",

number = "6",

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TY - JOUR

T1 - Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment

AU - Gyamfi-Bannerman, Cynthia

AU - Gilbert, Sharon

AU - Landon, Mark B.

AU - Spong, Catherine Y.

AU - Rouse, Dwight J.

AU - Varner, Michael W.

AU - Caritis, Steve N.

AU - Meis, Paul J.

AU - Wapner, Ronald J.

AU - Sorokin, Yoram

AU - Carpenter, Marshall

AU - Peaceman, Alan M.

AU - O'Sullivan, Mary J.

AU - Sibai, Baha M.

AU - Thorp, John M.

AU - Ramin, Susan M.

AU - Mercer, Brian M.

PY - 2012/12

Y1 - 2012/12

N2 - OBJECTIVE: Women with a prior myomectomy or prior classical cesarean delivery often have early delivery by cesarean because of concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well-quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. METHODS: Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery to estimate rates of both uterine rupture and placenta accreta. RESULTS: One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group (P>.99). CONCLUSION: A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low.

AB - OBJECTIVE: Women with a prior myomectomy or prior classical cesarean delivery often have early delivery by cesarean because of concern for uterine rupture. Although theoretically at increased risk for placenta accreta, this risk has not been well-quantified. Our objective was to estimate and compare the risks of uterine rupture and placenta accreta in women with prior uterine surgery. METHODS: Women with prior myomectomy or prior classical cesarean delivery were compared with women with a prior low-segment transverse cesarean delivery to estimate rates of both uterine rupture and placenta accreta. RESULTS: One hundred seventy-six women with a prior myomectomy, 455 with a prior classical cesarean delivery, and 13,273 women with a prior low-segment transverse cesarean delivery were evaluated. Mean gestational age at delivery differed by group (P<.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low-segment transverse cesarean delivery (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group (P-MMX group) was 0% (95% confidence interval [CI] 0-1.98%). The frequency of uterine rupture in the low-segment transverse cesarean delivery group (LTC group) (0.41%) was not statistically different from the risk in the P-MMX group (P>.99) or in the prior classical cesarean delivery group (PC group) (0.88%; P=.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of the P-MMX group compared with 0.19% in the LTC group (P>.99) and 0.88% in the PC group (P=.01 relative to the LTC group). The adjusted odds ratio for the PC group (relative to LTC group) was 3.23 (95% CI 1.11-9.39) for uterine rupture and 2.09 (95% CI 0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the PC group and 13.6% for the LTC group (P>.99). CONCLUSION: A prior myomectomy is not associated with higher risks of either uterine rupture or placenta accreta. The absolute risks of uterine rupture and accreta after prior myomectomy are low.

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Risk of uterine rupture and placenta accreta with prior uterine surgery outside of the lower segment

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