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Hysterotomy level at Cesarean section and occurrence of large scar defects : a randomized single-blind trial

Vikhareva, O. LU ; Rickle, G. S. LU ; Lavesson, T. LU ; Nedopekina, E. LU ; Brandell, K. and Salvesen, K. LU (2019) In Ultrasound in Obstetrics and Gynecology 53(4). p.438-442
Abstract

Objective: To study the association between the level of Cesarean hysterotomy and the presence of large uterine scar defects 6–9 months after delivery. Methods: This was a two-center, randomized, single-blind trial of a surgical procedure with masked assessment of the principal outcome under study. Women without a history of Cesarean section (CS) who underwent emergency CS at cervical dilatation ≥ 5 cm were randomized to high or low incision. Hysterotomy was performed 2 cm above and 2 cm below the plica vesicouterina in the high and low incision groups, respectively. Women were examined using saline contrast sonohysterography to assess the appearance of the hysterotomy scar 6–9 months after delivery. The main outcome was presence of a... (More)

Objective: To study the association between the level of Cesarean hysterotomy and the presence of large uterine scar defects 6–9 months after delivery. Methods: This was a two-center, randomized, single-blind trial of a surgical procedure with masked assessment of the principal outcome under study. Women without a history of Cesarean section (CS) who underwent emergency CS at cervical dilatation ≥ 5 cm were randomized to high or low incision. Hysterotomy was performed 2 cm above and 2 cm below the plica vesicouterina in the high and low incision groups, respectively. Women were examined using saline contrast sonohysterography to assess the appearance of the hysterotomy scar 6–9 months after delivery. The main outcome was presence of a large scar defect, defined as the remaining myometrial thickness over the defect being ≤ 2.5 mm. Secondary outcomes were perinatal outcome, operative complications within 8 weeks after delivery and long-term outcome in a subsequent pregnancy. Results: Of 122 patients enrolled in the trial, 114 were assessed by ultrasound examination, of whom 55 were randomized to high and 59 to low CS incision. Large scar defects were seen in four (7%) women in the high-incision group and in 24 (41%) in the low-incision group (P < 0.001; odds ratio, 8.7 (95% CI, 2.8–27.4)). There were no differences in operative complications and perinatal outcomes between the two groups. The median follow-up time was 4 years and 7 months, during which 56 (49%) women had a subsequent pregnancy. No significant differences were observed in the rate of complications in subsequent pregnancy and delivery between women who had low and those who had high incision at the index CS. Conclusion: Low Cesarean hysterotomy level in women in advanced labor is associated with higher incidence of large scar defects detected by transvaginal ultrasound examination 6–9 months after delivery.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cesarean scar, Cesarean section, scar defect, vaginal birth after Cesarean section
in
Ultrasound in Obstetrics and Gynecology
volume
53
issue
4
pages
5 pages
publisher
John Wiley and Sons Inc.
external identifiers
  • scopus:85063672895
  • pmid:30484920
ISSN
0960-7692
DOI
10.1002/uog.20184
language
English
LU publication?
yes
id
7ffb1037-38f4-4174-b341-940a20af3870
date added to LUP
2019-04-09 10:32:46
date last changed
2020-07-12 05:53:30
@article{7ffb1037-38f4-4174-b341-940a20af3870,
  abstract     = {<p>Objective: To study the association between the level of Cesarean hysterotomy and the presence of large uterine scar defects 6–9 months after delivery. Methods: This was a two-center, randomized, single-blind trial of a surgical procedure with masked assessment of the principal outcome under study. Women without a history of Cesarean section (CS) who underwent emergency CS at cervical dilatation ≥ 5 cm were randomized to high or low incision. Hysterotomy was performed 2 cm above and 2 cm below the plica vesicouterina in the high and low incision groups, respectively. Women were examined using saline contrast sonohysterography to assess the appearance of the hysterotomy scar 6–9 months after delivery. The main outcome was presence of a large scar defect, defined as the remaining myometrial thickness over the defect being ≤ 2.5 mm. Secondary outcomes were perinatal outcome, operative complications within 8 weeks after delivery and long-term outcome in a subsequent pregnancy. Results: Of 122 patients enrolled in the trial, 114 were assessed by ultrasound examination, of whom 55 were randomized to high and 59 to low CS incision. Large scar defects were seen in four (7%) women in the high-incision group and in 24 (41%) in the low-incision group (P &lt; 0.001; odds ratio, 8.7 (95% CI, 2.8–27.4)). There were no differences in operative complications and perinatal outcomes between the two groups. The median follow-up time was 4 years and 7 months, during which 56 (49%) women had a subsequent pregnancy. No significant differences were observed in the rate of complications in subsequent pregnancy and delivery between women who had low and those who had high incision at the index CS. Conclusion: Low Cesarean hysterotomy level in women in advanced labor is associated with higher incidence of large scar defects detected by transvaginal ultrasound examination 6–9 months after delivery.</p>},
  author       = {Vikhareva, O. and Rickle, G. S. and Lavesson, T. and Nedopekina, E. and Brandell, K. and Salvesen, K.},
  issn         = {0960-7692},
  language     = {eng},
  number       = {4},
  pages        = {438--442},
  publisher    = {John Wiley and Sons Inc.},
  series       = {Ultrasound in Obstetrics and Gynecology},
  title        = {Hysterotomy level at Cesarean section and occurrence of large scar defects : a randomized single-blind trial},
  url          = {http://dx.doi.org/10.1002/uog.20184},
  doi          = {10.1002/uog.20184},
  volume       = {53},
  year         = {2019},
}