OC14.05: Longitudinal transvaginal ultrasound evaluation of the Caesarean scar thickness after single or double layer uterotomy closure

Abstract

Objectives:The correlation between surgical technique and uterine scar remodelling after Caesarean delivery is controversially discussed. The aim of this prospective randomised study was to evaluate the uterine scar healing longitudinally by transvaginal ultrasound after single-or double layer uterine closure. Methods: The women were allocated for three different uterotomy suture techniques: a continuous single layer unlocked suture versus continuous single locked layer versus double layer. Double layer technique consisted of a first continuous unlocked layer and a second continuous non-locking imbricating suture. Transvaginal ultrasound evaluation of the uterine scar thickness was performed six weeks and six to twenty-four months after Caesarean delivery, respectively. The sonographers were blinded to the closure technique. Results: 435 patients were included in the present analysis. In 139 women a single layer unlocked suture was performed. 196 patients received a single locked layer and 100 a double layer suture. At six weeks postpartum the mean values of the scar thickness were not significantly different between the three groups (10.2+/-2.9mm vs 10.2+/-2.6 vs 10.8+/-3.3mm). At the second follow-up, 198 women were examined. The mean uterine scar measurements were significantly (p = 0.035) thicker after a double layer closure (7.8+/-2.3 mm) in comparison to a single layer unlocked suture (6.9+/-2.3mm). There was a trend (p = 0.051) that associated a single layer locked closure with a thinner scar (7.0+/-2.4mm) when compared to a double layer suture, respectively. Conclusions: We found that the myometrium thickness at least six month after delivery was significantly increased with double layer closure when compared with single layer unlocked suture of the low transverse uterine incision. Further work is needed to evaluate whether the increased scar thickness is a sign of good scar healing and protective of uterine rupture in a trial of labour in subsequent pregnancies. OC14.06The role of prior uterine closure on the lower uterine segment thickness measurement: a multicentre prospective study Objectives: To compare third-trimester lower uterine segment thickness (LUST) in women who had single vs double-layer uterine closure at previous Caesarean. Methods: Prospective study including women with a prior single low-transverse Caesarean recruited at 34-38 weeks of gestation. Transabdominal and transvaginal evaluation of LUST was measured at least 3 times by an observer unaware of all clinical data and the thinnest measurement was considered. Previous operative reports and medical records were subsequently reviewed to obtain the type of previous uterine closure and other potential confounding factors.Stepwise linear regression analyses were performed to estimate the association between risk factors of uterine rupture (including single vs double-layer closure) and third-trimester LUST.Results: Out of 1853 women recruited at a mean gestational age of 36.7 ± 1.2 weeks, 505 (27%) had a single-layer; 1114 (60%) had a dou...

Changes in the Uterine Scar during the First Year after a Caesarean Section: A Prospective Longitudinal Study

“…They all evaluated niches with a follow-up between 6 weeks and 24 months. Three of these studies also found a reduction of the RMT in time [14][15][16]. A reduction in the RMT and the AM/RM ratio over time could be induced by the continuing tissue reaction or reduction of oedema during the healing process.…”

“…Since the majority of the included women had a uterus closed in one layer, these results cannot be extrapolated to women who received double layer closure of their uterus. So far only 2 peer-reviewed studies and four abstracts were published on longitudinal follow-up within patients with niches by 2D or 3D ultrasound [14][15][16][17][18][19]. They all evaluated niches with a follow-up between 6 weeks and 24 months.…”