Previous cesarean scar exploration following vaginal delivery and hemorrhagic morbidity

Abstract

Manual scar exploration (or uterine revision) is routinely performed following vaginal delivery in women who underwent a previous cesarean section, although little is known about whether this procedure increases the risk of hemorrhagic scars and associated morbidity [1]. The purpose of this randomized trial was to determine whether uterine revision increased this risk.The trial was performed at the Obstetric and Gynecologic department of F. Hached Hospital, Sousse, Tunisia, after approval from the ethics committee, and all participants provided informed consent.Inclusion criteria were pregnancy duration of more than 35 weeks, vaginal delivery of a single live newborn, third stage of labor less than 30 min, and no chorioamnionitis, antepartum hemorrhage, placenta previa, or known coagulopathy.The women were assigned to 1 of 2 groups. In one group, uterine scar exploration was systematically performed after vaginal delivery; in the other group, it was performed only in women who were 0020-7292/$ -see front matter D (M. Jerbi). KEYWORDSScarred uterus; Vaginal delivery; Dehiscence Vaginal deliveries (n=5441) Vaginal birth after cesarean section (n=312) Randomly allocated management (n=130) Systematic scar exploration (n=65) Symptomatic patient scar exploration (n=65) Completed trial (n=65) Completed trial (n=65) Did not consent (n=182) Figure 1 Trial profile.