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Am J Perinatol
DOI: 10.1055/a-2022-9892
Original Article

Uterine Scar Evaluation during the Postpartum: Pleading for Extradecidual Suturing during Cesarean Section

Assaad K. Kesrouani 
1   Obstetrics and Gynecology Department, St. Joseph University, Beirut, Lebanon
2   Department of Obstetrics and Gynecology, Hotel-Dieu de France University Hospital, Prenatal Unit, Bellevue Medical Center, Lebanon
,
Yara Abdelkhalek
1   Obstetrics and Gynecology Department, St. Joseph University, Beirut, Lebanon
2   Department of Obstetrics and Gynecology, Hotel-Dieu de France University Hospital, Prenatal Unit, Bellevue Medical Center, Lebanon
,
Wael Abdallah
1   Obstetrics and Gynecology Department, St. Joseph University, Beirut, Lebanon
2   Department of Obstetrics and Gynecology, Hotel-Dieu de France University Hospital, Prenatal Unit, Bellevue Medical Center, Lebanon
,
Christian Chaccour
1   Obstetrics and Gynecology Department, St. Joseph University, Beirut, Lebanon
2   Department of Obstetrics and Gynecology, Hotel-Dieu de France University Hospital, Prenatal Unit, Bellevue Medical Center, Lebanon
,
Inaam Hatoum
3   Obstetrics and Gynecology Department, Rafik Hariri University Hospital, Beirut, Lebanom
,
Freda Richa
4   Anesthesia Department, St. Joseph University, Hotel-Dieu de France University Hospital, Beirut, Lebanon
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Abstract

Objective Our objective is to evaluate ultrasound differences in uterine scar between techniques using extramucosal suturing and full thickness suturing of the uterine incision.

Study Design A retrospective observational study included cases of primary cesarean section. At 6-week postpartum, we evaluated by endovaginal ultrasound two elements in the sagittal view: the thickness of the uterine scar and the surface of defect (niche). Hysterotomy sites closed using a running full-thickness technique including the uterine mucosa (group 1) were compared to hysterotomies operated by the same surgeon but with extramucosal suturing (group 2). The operator switched from the running suture technique to extramucosal in 2013.

Results The study included 241 patients (115 cases in group 1 that were compared to 126 cases in group 2). There were no significant differences in age or body mass index between the two groups. Cesarean scar and niche were detectable in the entire studied population. There was a significant difference in both uterine scar thickness (5.8 vs. 6.2 mm, p = 0.02) and the presence and size of the niche (49 vs. 40 mm2, p = 0.001) in transvaginal ultrasound performed at 6-week postpartum.

Conclusion Extramucosal suturing of the uterine scar seems to be associated with a better outcome on the postpartum ultrasound evaluation.

Key Points

  • The technique for suturing the hysterotomy can be the source of healing changes.

  • An extramucosal suturing of the uterus seems to give a better aspect at the postpartum ultrasound.

  • Decreasing the niche at cesarean scar may be beneficial for future pregnancies.

Keywords

cesarean section - suturing technique - scar - niche - ultrasound

Synopsis

Comparing the full-thickness suturing technique to extramucosal suturing of the uterine incision showed a better scar on postpartum ultrasound evaluation.




Publication History

Received: 09 October 2022

Accepted: 26 January 2023

Accepted Manuscript online:
31 January 2023

Article published online:
07 March 2023

© 2023. Thieme. All rights reserved.

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