Vertical versus transverse abdominal incision in placental abruption: a propensity score-matched study on the trade-off between speed and maternal-neonatal safety.

OBJECTIVE

To compare maternal and neonatal outcomes between midline vertical and transverse abdominal incisions during emergency cesarean delivery for placental abruption.

METHODS

In this retrospective cohort study, 152 patients were included. Propensity score matching (PSM) was used to balance baseline characteristics, resulting in 106 well-matched patients (41 vertical, 65 transverse). Surgical metrics, laboratory parameters, and a composite adverse outcome were compared. Independent predictors were identified via multivariate logistic regression.

RESULTS

After PSM, the vertical group had a shorter median decision-to-delivery interval (DDI: 17.0 vs. 28.0 min, p < 0.001) but a significantly higher incidence of the composite adverse outcome (75.6% vs. 32.3%, p < 0.001), surgical site complications (29.3% vs. 0%), preterm birth, neonatal asphyxia, and NICU admission. Vertical incision (adjusted OR = 3.59, 95% CI 1.04-12.38), earlier gestational age, lower preoperative fibrinogen, and shorter DDI were independent risk factors.

CONCLUSION

In this PSM analysis, vertical incision was associated with faster delivery but also with significantly worse composite maternal-neonatal outcomes. These findings underscore a trade-off between speed and morbidity. However, confounding by indication may influence this association. Incision selection in this setting warrants individualized assessment.