Ultrasound Evaluation of the Uterine Scar After Cesarean Delivery: A Randomized Controlled Trial of One- and Two-Layer Closure

Ceci, Oronzo; Scioscia, Marco; Bettocchi, Stefano; Cantatore, Clementina; Nardelli, Claudia; Laera, A.F.; Vimercati, Antonella

doi:10.1097/aog.0b013e318163c90b

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…These various outcomes could explain long‐term complications at a later pregnancy with a cesarean pouch‐like ectopic scar, when the placenta is located on the lower anterior uterine wall where vascularized endometrial tissue has grown at the site of the cesarean scar. Cesarean scar defects are also responsible for post‐menstrual bleeding due to a dark‐blood collection beneath the scar pouch and secondary infertility, as previously reported 11–13,23 . The pathogenesis of these abnormal symptoms, and their evolution in the years after the cesarean delivery, could be explained by the hysteroscopic findings observed in our patients.…”

Section: Discussionsupporting

confidence: 75%

“…Cesarean scar defects are also responsible for post-menstrual bleeding due to a dark-blood collection beneath the scar pouch and secondary infertility, as previously reported. [11][12][13]23 The pathogenesis of these abnormal symptoms, and their evolution in the years after the cesarean delivery, could be explained by the hysteroscopic findings observed in our patients.…”

Section: Discussionmentioning

confidence: 53%

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

Ceci

Cantatore

Scioscia

et al. 2012

J of Obstet and Gynaecol

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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.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 53%

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

Ceci

Cantatore

Scioscia

et al. 2012

J of Obstet and Gynaecol

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“…19 With cesarean section delivery, uterine scar thickness is still increased at the six-week postnatal point indicating continued remodeling despite the fact that many women are told that they may begin unrestricted activity at this point, and notable pelvic floor dysfunction including weakness or difficulty with coordination may also still be present associated with the pressure of the growing uterus throughout pregnancy. 20 "CORE CANISTER" HEALTH AND DYSFUNCTION Pregnant and postpartum women may have limited education on their own bodies and the musculoskeletal adaptations that occur. They may also not realize that many of the symptoms that they may experience in pregnancy and postpartum are common but not normal.…”

Section: Adaptations To Pregnancy and Postpartummentioning

confidence: 99%

Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport

Selman

Early

Battles³

et al. 2022

International Journal of Sports Physical Therapy

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Increased participation and duration in sport has become commonplace for women with their involvement often including the transition to motherhood in the peak of their athletic careers. No rehabilitation models that assess the full spectrum of pregnancy to postpartum have been developed for women to assist in safe exercise progressions that reduce postpartum symptoms and optimize performance during the return to full activity. Referral to physical therapy both in the prenatal and postnatal period is currently not considered standard of care to reduce prevalence of symptoms such as musculoskeletal pain, diastasis recti, and pelvic floor dysfunction which may ultimately interfere with physical activity and performance. This commentary presents a timeline and suggested progression for exercise participation to improve awareness of the musculoskeletal changes that occur after labor and delivery. The concepts covered may increase the understanding of how to manage pregnant and postpartum athletes from a musculoskeletal perspective and serve as a starting point for establishing appropriate and guided rehabilitation for safe return to sport after childbirth.

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“…Significant variations in scar thickness occurred over time, but were unrelated to the type of uterine closure. The methodological approach was criticized mainly for its use of sonographic assessment (transabdominal: 83 -85 %; transvaginal: 15 -17 %) and its shortness of fol-low-up [18]. A previous study, which used magnetic resonance imaging, suggested that scar remodeling may not be complete until up to six months after Cesarean delivery [19].…”

Section: Comparison With Findings Of Previous Studiesmentioning

confidence: 99%

A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness

et al. 2016

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Ultrasound Evaluation of the Uterine Scar After Cesarean Delivery: A Randomized Controlled Trial of One- and Two-Layer Closure

Cited by 4 publications

References 3 publications

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

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

Maximizing Recovery in the Postpartum Period: A Timeline for Rehabilitation from Pregnancy through Return to Sport

A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness

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