{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T13:17:19Z","timestamp":1788182239195,"version":"build-2803163510"},"reference-count":21,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"vor","delay-in-days":22,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pregnancy"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate multiple uterine closure techniques during cesarean delivery (CD) and placenta accreta spectrum (PAS) incidence in the following pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review with meta\u2010analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources<\/jats:title>\n                    <jats:p>Medline, Cochrane Library, EMBASE, PubMed Central, Scopus, and ClinicalTrial.gov were electronically searched from their inception to September 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Eligibility criteria for selecting studies<\/jats:title>\n                    <jats:p>We included all studies with a control population that compared different uterine closure techniques during CD\u2014namely (1) type of suture; (2) inclusion or not of the decidua; (3) continuous versus interrupted suture; (4) locking versus non\u2010locking suture; (5) pursed\u2010string or not; (6) single\u2010 versus double\u2010layer suture\u2014with PAS incidence at the following pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data synthesis<\/jats:title>\n                    <jats:p>The primary outcome was PAS incidence at the following pregnancy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We could not find any controlled study with follow\u2010up data for PAS at the subsequent pregnancy in terms of type of suture utilized, inclusion or not of the decidua, or pursed\u2010string closure at index CD. Three trials, including 1787 pregnancies, were analyzed and judged as \u201chigh quality,\u201d showing a potential association between continuous versus interrupted suture and PAS, but no difference with respect to locking versus non\u2010locking or single\u2010 versus double\u2010layer closures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmf2.70244","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T09:26:58Z","timestamp":1769160418000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Uterine closure techniques during cesarean delivery and placenta accreta spectrum incidence in subsequent pregnancies: A systematic review and meta\u2010analysis"],"prefix":"10.1002","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-3689-8042","authenticated-orcid":false,"given":"Alessandro","family":"Petrecca","sequence":"first","affiliation":[{"name":"Department of Woman and Child Health and Public Health Sciences Fondazione Policlinico A. Gemelli IRCSS, Catholic University of the Sacred Heart  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie","family":"Gomez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan","family":"Raymond","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1590-3942","authenticated-orcid":false,"given":"Chiara","family":"Tersigni","sequence":"additional","affiliation":[{"name":"Department of Woman and Child Health and Public Health Sciences Fondazione Policlinico A. Gemelli IRCSS, Catholic University of the Sacred Heart  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenzo","family":"Berghella","sequence":"additional","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Department of Obstetrics and Gynecology Sidney Kimmel Medical College of Thomas Jefferson University  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1709324"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(18)32394\u20108"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0148343"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajogmf.2023.101186"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102021\u2010005671"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2021.02.001"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2017.05.067"},{"key":"e_1_2_10_9_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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