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Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure

INTRODUCTION: This study compared healing of the scars after cesarean section during the first postpartum year using a single‐ or double‐layer suturing technique. Scarring was assessed by a transvaginal ultrasound. We explored the appearance and localization of uterine scars with regard to the obste...

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Autores principales: Hanacek, Jiri, Vojtech, Jiri, Urbankova, Iva, Krcmar, Michal, Křepelka, Petr, Feyereisl, Jaroslav, Krofta, Ladislav
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973250/
https://www.ncbi.nlm.nih.gov/pubmed/31441500
http://dx.doi.org/10.1111/aogs.13714
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author Hanacek, Jiri
Vojtech, Jiri
Urbankova, Iva
Krcmar, Michal
Křepelka, Petr
Feyereisl, Jaroslav
Krofta, Ladislav
author_facet Hanacek, Jiri
Vojtech, Jiri
Urbankova, Iva
Krcmar, Michal
Křepelka, Petr
Feyereisl, Jaroslav
Krofta, Ladislav
author_sort Hanacek, Jiri
collection PubMed
description INTRODUCTION: This study compared healing of the scars after cesarean section during the first postpartum year using a single‐ or double‐layer suturing technique. Scarring was assessed by a transvaginal ultrasound. We explored the appearance and localization of uterine scars with regard to the obstetric history. Our aim was to compare the position of the scar or defect, if present, its dimensions, and any residual myometrium with respect to the suturing technique during the cesarean section. MATERIAL AND METHODS: Women with uncomplicated singleton pregnancies indicated for elective or acute cesarean section were randomly allocated to the uterine closure technique group. During the first postpartum year, their lower uterine segment was examined with a transvaginal ultrasound in three consecutive visits at 6 weeks, 6 months and 12 months. RESULTS: 324 women attended the 12‐month visit; of these, 149 underwent single‐layer closure of the uterine incision and 175 double‐layer technique. A higher proportion of the defects is seen in the single‐layer closure technique of suturing. Defects in the single‐layer group were wider (0.002) and the residual myometrial thickness in the single‐layer group were thinner (0.019). Women who underwent cesarean section at the stage of full cervical dilation had scars that were closer to the external cervical os (0.000). The position of the uterus varies greatly between controls (0.000). The combination of uterine position and scar defect presence changed significantly between controls (0.001), and was significantly dependent on the suturing method (0.003). Defects with or without contact with the uterine cavity changed statistically between controls (0.017). Both types of defects were more common in the single‐layer closure technique group. CONCLUSIONS: The findings of this study demonstrate that double‐layer technique with the first continuous nonlocking suture followed by a second continuous nonlocking suture is associated with better suture healing and greater residual myometrial thickness. No difference was observed between single‐ and double‐layer closure for the presence of maternal infectious morbidity, wound infection or blood transfusion.
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spelling pubmed-69732502020-01-27 Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure Hanacek, Jiri Vojtech, Jiri Urbankova, Iva Krcmar, Michal Křepelka, Petr Feyereisl, Jaroslav Krofta, Ladislav Acta Obstet Gynecol Scand Fertility INTRODUCTION: This study compared healing of the scars after cesarean section during the first postpartum year using a single‐ or double‐layer suturing technique. Scarring was assessed by a transvaginal ultrasound. We explored the appearance and localization of uterine scars with regard to the obstetric history. Our aim was to compare the position of the scar or defect, if present, its dimensions, and any residual myometrium with respect to the suturing technique during the cesarean section. MATERIAL AND METHODS: Women with uncomplicated singleton pregnancies indicated for elective or acute cesarean section were randomly allocated to the uterine closure technique group. During the first postpartum year, their lower uterine segment was examined with a transvaginal ultrasound in three consecutive visits at 6 weeks, 6 months and 12 months. RESULTS: 324 women attended the 12‐month visit; of these, 149 underwent single‐layer closure of the uterine incision and 175 double‐layer technique. A higher proportion of the defects is seen in the single‐layer closure technique of suturing. Defects in the single‐layer group were wider (0.002) and the residual myometrial thickness in the single‐layer group were thinner (0.019). Women who underwent cesarean section at the stage of full cervical dilation had scars that were closer to the external cervical os (0.000). The position of the uterus varies greatly between controls (0.000). The combination of uterine position and scar defect presence changed significantly between controls (0.001), and was significantly dependent on the suturing method (0.003). Defects with or without contact with the uterine cavity changed statistically between controls (0.017). Both types of defects were more common in the single‐layer closure technique group. CONCLUSIONS: The findings of this study demonstrate that double‐layer technique with the first continuous nonlocking suture followed by a second continuous nonlocking suture is associated with better suture healing and greater residual myometrial thickness. No difference was observed between single‐ and double‐layer closure for the presence of maternal infectious morbidity, wound infection or blood transfusion. John Wiley and Sons Inc. 2019-09-26 2020-01 /pmc/articles/PMC6973250/ /pubmed/31441500 http://dx.doi.org/10.1111/aogs.13714 Text en © 2019 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG) This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Fertility
Hanacek, Jiri
Vojtech, Jiri
Urbankova, Iva
Krcmar, Michal
Křepelka, Petr
Feyereisl, Jaroslav
Krofta, Ladislav
Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
title Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
title_full Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
title_fullStr Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
title_full_unstemmed Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
title_short Ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
title_sort ultrasound cesarean scar assessment one year postpartum in relation to one‐ or two‐layer uterine suture closure
topic Fertility
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6973250/
https://www.ncbi.nlm.nih.gov/pubmed/31441500
http://dx.doi.org/10.1111/aogs.13714
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