Perioperative Outcomes Associated With Different Uterine Incision Techniques During Cesarean Delivery for Placenta Accreta Spectrum: A Systematic Review and Single-Arm Meta-Analysis

Perioperative Outcomes Associated With Different Uterine Incision Techniques During Cesarean Delivery for Placenta Accreta Spectrum: A Systematic Review and Single-Arm Meta-Analysis | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 8 February 2026 V1 Latest version Share on Perioperative Outcomes Associated With Different Uterine Incision Techniques During Cesarean Delivery for Placenta Accreta Spectrum: A Systematic Review and Single-Arm Meta-Analysis Authors : Laura Fonseca Queiroz 0009-0008-9162-5335 [email protected] , Juliana V. Q. A. Oliveira 0000-0002-4704-2318 , Maria Julia Lemos 0009-0007-9778-9624 , and Rodrigo Ruano 0000-0002-3642-5858 Authors Info & Affiliations https://doi.org/10.22541/au.177059357.78555689/v1 157 views 93 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract Background: Placenta accreta spectrum (PAS) is associated with high maternal and fetal morbidity due to massive hemorrhage. Optimal cesarean uterine incision techniques for PAS remain debated, particularly non–lower segment approaches aimed at avoiding direct placental transection. Objectives: To systematically review and synthesize perioperative outcomes associated with different non–lower segment uterine incisions, including transverse fundal uterine incision (TFUI), parallel transverse uterine incision (PTUI), and fundal longitudinal incision, in cesarean deliveries for PAS. Search Strategy: A systematic search of PubMed, Embase, and CENTRAL was performed from inception to December 30, 2025, without language restrictions. Reference lists of included studies were also screened. Selection Criteria: Observational and randomized studies reporting perioperative outcomes in PAS patients undergoing cesarean delivery with TFUI, PTUI, or fundal longitudinal incision. Studies had to report at least one prespecified outcome. Data Collection and Analysis: Two reviewers independently extracted data on maternal characteristics, PAS classification, surgical details, blood loss, postoperative hemoglobin, hysterectomy rates, operative time, and hospital stay. Single-arm meta-analyses were conducted using random-effects models. Subgroup analyses were performed according to incision type. Main Results: Eight studies (n = 228) were included. Mean maternal age was 33.4 years, gestational age 34.7 weeks, and previous cesarean rate 94.9%. Overall mean operative time was 152.5 minutes, mean estimated blood loss 2090 mL, mean postoperative hemoglobin 10.86 mg/dL, and cesarean hysterectomy rate 28%. TFUI was associated with lower blood loss (1471 mL) but longer operative time (177 minutes), whereas PTUI showed higher blood loss (2682 mL) but shorter surgery (146 minutes) and lower hysterectomy rates. Fundal longitudinal incision data were limited. Considerable heterogeneity was observed across studies. Conclusions: TFUI may reduce blood loss but is associated with longer surgery and higher hysterectomy rates, whereas PTUI may allow faster surgery with higher blood loss but lower hysterectomy rates. Individualized incision planning, guided by placental location, PAS depth, and surgical expertise, is essential to optimize maternal outcomes. High-quality prospective studies are needed for comparative evaluation of these techniques. Supplementary Material File (1. manuscript (2).docx) Download 3.70 MB File (appendix s1.docx) Download 14.33 KB File (appendix s2.docx) Download 15.79 KB Information & Authors Information Version history V1 Version 1 08 February 2026 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords delivery: caesarean section general obstetrics meta-analysis obstetric haemorrhage placental pathology Authors Affiliations Laura Fonseca Queiroz 0009-0008-9162-5335 [email protected] Santa Casa de Misericordia de Belo Horizonte View all articles by this author Juliana V. Q. A. Oliveira 0000-0002-4704-2318 Universidade Federal de Minas Gerais View all articles by this author Maria Julia Lemos 0009-0007-9778-9624 UniRedentor View all articles by this author Rodrigo Ruano 0000-0002-3642-5858 University of Miami Miller School of Medicine View all articles by this author Metrics & Citations Metrics Article Usage 157 views 93 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Laura Fonseca Queiroz, Juliana V. Q. A. Oliveira, Maria Julia Lemos, et al. Perioperative Outcomes Associated With Different Uterine Incision Techniques During Cesarean Delivery for Placenta Accreta Spectrum: A Systematic Review and Single-Arm Meta-Analysis. Authorea . 08 February 2026. DOI: https://doi.org/10.22541/au.177059357.78555689/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. 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