Transverse versus Vertical Incision in the Surgical Management of Placenta Accreta Spectrum

Area of Science:

• Obstetrics and Gynecology
• Surgical Oncology
• Maternal-Fetal Medicine

Background:

• Midline vertical skin incisions are traditionally used for placenta accreta spectrum (PAS) surgery to maximize exposure.
• Limited literature compares maternal outcomes between vertical and transverse skin incisions in PAS.
• The study aims to compare outcomes of vertical versus transverse skin incisions in PAS surgery.

Purpose of the Study:

• To compare maternal outcomes between patients undergoing vertical versus transverse skin incisions for PAS.
• To evaluate the rates of blood transfusion, surgical complications, and conversion to general anesthesia (GETA).

Main Methods:

• Retrospective review of 70 patients with confirmed PAS undergoing scheduled surgery (September 2019 - November 2023).
• Comparison between vertical (n=33) and transverse (n=37) skin incisions, with transverse incisions offered from October 2021.
• Inclusion criteria: scheduled surgery, placenta not fully covering anterior uterine wall.

Main Results:

• No significant difference in transfusion rates (>4 units PRBCs) or intraoperative complications (e.g., cystotomy).
• Transverse incision group showed significantly lower conversion to general anesthesia (GETA) rates (24% vs. 70%, p<0.001).
• 86% of eligible patients opted for the transverse incision after its introduction, with no intraoperative conversion to vertical.

Conclusions:

• A transverse skin incision is a viable alternative for selected PAS patients, offering equivalent surgical outcomes.
• Transverse incisions for PAS are associated with a significantly reduced need for conversion to general anesthesia.
• This approach may lead to improved patient recovery, potentially including reduced narcotic requirements.