Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: Comparison of two types of single‐layer suture

Abstract

Aim: A common anatomical consequence of low‐segment cesarean section is the presence of a pouch on the anterior uterine wall that can be detected by sonography or hysteroscopy. Different suturing techniques have been compared (single vs double layer) and showed no substantial differences. This prospective longitudinal study was aimed at evaluating the outcome of the cesarean scar, comparing two different types of single‐layer sutures by transvaginal ultrasound and hysteroscopy. Material and Methods: The study sample consisted of two groups of 30 singleton primiparae at term who delivered by elective low segment cesarean section. In the first group, uterine closure was done with locked continuous single‐layer sutures and in the second group, with single‐layer interrupted sutures. Patients were assessed by transvaginal ultrasound and hysteroscopy, between the 6th and the 12th month after delivery, and again at the 24th month. Ultrasound measurements were made of the pouch area, if present. Results: A bell‐shaped uterine wall defect was seen at ultrasound in 36 (85.71%) of 42 patients who completed the follow up at the 24th month. It was larger in the group of patients with closure by continuous sutures (6.2 [2.1–14.7] mm2) as compared to interrupted sutures (4.6 [1.9–8.2] mm2, P = 0.03). Hysteroscopy confirmed the presence of the wall defect in all 36 cases, but different hysteroscopic outcomes were observed. Conclusion: Locked continuous sutures seem to cause a larger defect as compared to interrupted sutures, probably due to a greater ischemic effect exerted on the uterine tissue.

Laparoscopic isthmocele treatment - single center experience.

“…Because of that, the risk of severe obstetric complications, such as uterine rupture, subsequent hemorrhage or morbidly adherent placenta, is still very high, regardless of the present therapeutic achievements [11, 15, 38–40]. The exact reasons for scar defects after cesarean sections still remain unknown [41, 42]. …”

“…It might also be a treatment option (depending on the center) [5, 9, 14, 34, 41, 43–45]. In the ultrasound, the isthmocele appears as a hypoechoic triangular area in the previous hysterotomy place.…”

Why Do Niches Develop in Caesarean Uterine Scars? Hypotheses on the Aetiology of Niche Development

“…One RCT and a prospective longitudinal study compared locked to unlocked sutures (Yasmin et al, 2011;Ceci et al, 2012). Yasmin et al showed decreased myometrial thickness (60 patients; mean difference, 22.5; 95% CI, 23.2 to 21.8; P , 0.001) and increased blood loss (60 patients; mean difference, 45.0 ml; 95% CI, 21.6 -68.4; P , 0.001) with locking of the first layer.…”

Laparoscopic correction of the uterine muscle loss in the scar after a Caesarean section delivery.

“…The niche is visible during the examination as a triangular hypoechogenic area, with its apex directed towards the anterior wall of the uterine isthmus, whereas the base is directed towards its posterior wall. Other methods used in “isthmocele” diagnostics are endoscopic techniques (mainly hysteroscopy) [10, 13, 18, 23, 27, 28, 32, 33]. …”