Authors' reply: Transverse uterine fundal incision for placenta praevia with accreta

Nishijima, Koji; Yoshida, Yoshio; Kotsuji, Fumikazu

doi:10.1111/1471-0528.12550

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…An incision into the placenta can be completely avoided with TUFI. In addition, bleeding is minimal because the muscle layer of the uterine fundus is thinner than the uterine body [ 7 ] and the incision is made parallel to the path of the arcuate artery [ 8 ]. TUFI is also characterized by strong uterine contractions after placental delivery [ 7 , 9 ], which suppress bleeding from the detached plane of the placenta without the need for additional compression hemostatic methods.…”

Section: Introductionmentioning

confidence: 99%

“…In addition, bleeding is minimal because the muscle layer of the uterine fundus is thinner than the uterine body [ 7 ] and the incision is made parallel to the path of the arcuate artery [ 8 ]. TUFI is also characterized by strong uterine contractions after placental delivery [ 7 , 9 ], which suppress bleeding from the detached plane of the placenta without the need for additional compression hemostatic methods. Due to its advantages of safety for the mother and neonate and ease of performance for the surgeon, TUFI is now widely used as an operative method for placenta previa-accreta [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study

Kotsuji,

Shibata,

Nakago

et al. 2024

BMC Pregnancy Childbirth

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Background Transverse uterine fundal incision (TUFI) is a beneficial procedure for mothers and babies at risk due to placenta previa-accreta, and has been implemented worldwide. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. We therefore evaluated the TUFI wound scar to determine the approval criteria for pregnancy after this surgery. Methods Between April 2012 and August 2022, we performed TUFI on 150 women. Among 132 of the 150 women whose uteruses were preserved after TUFI, 84 women wished to conceive again. The wound healing status, scar thickness, and resumption of blood flow were evaluated in these women by magnetic resonance imaging (MRI) and sonohysterogram at 12 months postoperatively. Furthermore, TUFI scars were directly observed during the Cesarean sections in women who subsequently conceived. Results Twelve women were lost to follow-up and one conceived before the evaluation, therefore 71 cases were analyzed. MRI scans revealed that the “scar thickness”, the thinnest part of the scar compared with the normal surrounding area, was ≥ 50% in all cases. The TUFI scars were enhanced in dynamic contrast-enhanced MRI except for four women. However, the scar thickness in these four patients was greater than 80%. Twenty-three of the 71 women conceived after TUFI and delivered live babies without notable problems until August 2022. Their MRI scans before pregnancy revealed scar thicknesses of 50–69% in two cases and ≥ 70% in the remaining 21 cases. And resumption of blood flow was confirmed in all patients except two cases whose scar thickness ≥ 90%. No evidence of scar healing failure was detected at subsequent Cesarean sections, but partial thinning was found in two patients whose scar thicknesses were 50–69%. In one woman who conceived seven months after TUFI and before the evaluation, uterine rupture occurred at 26 weeks of gestation. Conclusions Certain criteria, including an appropriate suture method, delayed conception for at least 12 months, evaluation of the TUFI scar at 12 months postoperatively, and cautious postoperative management, must all be met in order to approve a post-TUFI pregnancy. Possible scar condition criteria for permitting a subsequent pregnancy could include the scar thickness being ≥ 70% of the surrounding area on MRI scans, at least partially resumed blood flow, and no abnormalities on the sonohysterogram. Trial registration Retrospectively registered.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study

Kotsuji,

Shibata,

Nakago

et al. 2024

BMC Pregnancy Childbirth

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Updated criteria for the approval of subsequent pregnancy after cesarean section with a transverse uterine fundal incision based on 17 years of experience

Shibata,

Nishijima,

Nakago

et al. 2024

J of Obstet and Gynaecol

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In the case of placenta previa‐accreta when the placenta covers the entire anterior uterine wall, it is difficult to avoid transecting the placenta by traditional low‐transverse cesarean section (CS), resulting in catastrophic hemorrhage and fetal anemia. To prevent this critical risk, we developed the CS with transverse uterine fundal incision (TUFI) and this technique has been widely used as a beneficial surgical method in clinical practice owing to its safety advantages for the mother and neonate since our first report. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. Based on our 17 years of experience, patients who require TUFI do not need to avoid this beneficial operative method simply because of their desire to conceive again, as long as certain conditions can be met. To approve a post‐TUFI pregnancy, an appropriate suture method, delay in conception for at least 12 months with evaluation of the TUFI scar, and cautious postoperative management are at a minimum essential. In this article, we showed our recommendation for operative procedure and discuss the current status of the management of post‐TUFI pregnancies based on the evaluation of the TUFI wound scar and experience with postoperative pregnancies.

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Authors' reply: Transverse uterine fundal incision for placenta praevia with accreta

Cited by 2 publications

References 3 publications

Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study

Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study

Updated criteria for the approval of subsequent pregnancy after cesarean section with a transverse uterine fundal incision based on 17 years of experience

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