ArticlePregnancy (Hoboken, N.J.)2026
Uterine closure techniques during cesarean delivery and placenta accreta spectrum incidence in subsequent pregnancies: A systematic review and meta-analysis.
Article in Pregnancy (Hoboken, N.J.), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Objective: To evaluate multiple uterine closure techniques during cesarean delivery (CD) and placenta accreta spectrum (PAS) incidence in the following pregnancy. Design: Systematic review with meta-analysis. Data sources: Medline, Cochrane Library, EMBASE, PubMed Central, Scopus, and ClinicalTrial.gov were electronically searched from their inception to September 2025. Eligibility criteria for selecting studies: We included all studies with a control population that compared different uterine closure techniques during CD-namely (1) type of suture; (2) inclusion or not of the decidua; (3) continuous versus interrupted suture; (4) locking versus non-locking suture; (5) pursed-string or not; (6) single- versus double-layer suture-with PAS incidence at the following pregnancy. Data synthesis: The primary outcome was PAS incidence at the following pregnancy. Results: We could not find any controlled study with follow-up data for PAS at the subsequent pregnancy in terms of type of suture utilized, inclusion or not of the decidua, or pursed-string closure at index CD. Three trials, including 1787 pregnancies, were analyzed and judged as "high quality," showing a potential association between continuous versus interrupted suture and PAS, but no difference with respect to locking versus non-locking or single- versus double-layer closures. Conclusions: As of now, it is impossible to mandate a specific uterine closure technique during CD with the aim of reducing the incidence of PAS at the following pregnancy. Large randomized controlled trials are needed.
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