{"doi":"10.17615/483a-js15","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 are often delivered early by cesarean due to 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 to women with a prior low transverse cesarean 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 transverse cesarean were evaluated. Mean gestational age at delivery differed by group (p<0.001), prior myomectomy (37.3 weeks), prior classical cesarean delivery (35.8 weeks), and low transverse cesarean (38.6 weeks). The frequency of uterine rupture in the prior myomectomy group was 0% (95% CI 0-1.98%). The frequency of uterine rupture in the low transverse cesarean group (0.41%) was not statistically different from the risk in the prior myomectomy group (p>0.99) or in the prior classical cesarean delivery group (0.88%, p=0.13). Placenta accreta occurred in 0% (95% CI 0-1.98%) of prior myomectomy compared with 0.19% in the low transverse cesarean group (p>0.99) and 0.88% in the prior classical cesarean delivery group (p=0.01 relative to low transverse cesarean). The adjusted OR for the prior classical cesarean delivery group (relative to low transverse cesarean) was 3.23 (1.11-9.39) for uterine rupture and 2.09 (0.69-6.33) for accreta. The frequency of accreta for those with previa was 11.1% for the prior classical cesarean delivery and 13.6% for low transverse cesarean groups (p>0.99=1.0). 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.","journal":"Europe PMC (PubMed Central)","year":2021,"id":197190,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9572,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":592459,"name":"Paul J. Meis","orcid":null,"position":1,"is_corresponding":false},{"id":515706,"name":"Yoram Sorokin","orcid":null,"position":2,"is_corresponding":false},{"id":460635,"name":"Dwight J. Rouse","orcid":"0000-0002-9336-9688","position":3,"is_corresponding":false},{"id":331590,"name":"Steve N. Caritis","orcid":"0000-0002-2169-0712","position":4,"is_corresponding":false},{"id":456043,"name":"Brian M. Mercer","orcid":null,"position":5,"is_corresponding":false},{"id":544831,"name":"Catherine Y. Spong","orcid":null,"position":6,"is_corresponding":false},{"id":515117,"name":"Alan M. Peaceman","orcid":"0000-0002-4515-4850","position":7,"is_corresponding":false},{"id":592462,"name":"Sharon Gilbert","orcid":null,"position":8,"is_corresponding":false},{"id":592460,"name":"Cynthia Gyamfi-Bannerman","orcid":null,"position":9,"is_corresponding":false},{"id":592463,"name":"Marshall W. Carpenter","orcid":null,"position":10,"is_corresponding":false},{"id":505950,"name":"Baha M. Sibai","orcid":"0000-0001-9982-7873","position":11,"is_corresponding":false},{"id":373022,"name":"Susan M. Ramin","orcid":null,"position":12,"is_corresponding":false},{"id":377145,"name":"John M. Thorp","orcid":"0000-0002-4598-0271","position":13,"is_corresponding":false},{"id":388820,"name":"Michael W. Varner","orcid":"0000-0001-9455-3973","position":14,"is_corresponding":false},{"id":319134,"name":"Mark B. Landon","orcid":null,"position":15,"is_corresponding":false},{"id":771115,"name":"Mary O apos Sullivan","orcid":null,"position":16,"is_corresponding":false},{"id":262909,"name":"Ronald J. Wapner","orcid":"0000-0003-0727-1244","position":0,"is_corresponding":true}],"reference_count":0,"raw_metadata":null,"created_at":"2026-07-18T23:50:19.568641Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}