open access

Vol 88, No 4 (2017)
Research paper
Published online: 2017-04-28
Get Citation

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Michał Pomorski, Tomasz Fuchs, Anna Rosner-Tenerowicz, Mariusz Zimmer
DOI: 10.5603/GP.a2017.0034
·
Pubmed: 28509317
·
Ginekol Pol 2017;88(4):174-179.

open access

Vol 88, No 4 (2017)
ORIGINAL PAPERS Gynecology
Published online: 2017-04-28

Abstract

Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight.

Material and methods: 208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS.

Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24).

Conclusions: In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

Abstract

Objectives: A growing number of studies suggest that the incomplete healing of the CS scar in the uterus increase the risk of uterine dehiscence or rupture during subsequent pregnancies. Thus, the factors that affect wound healing should be evaluated. We aimed to determine whether the morphology of the CS scar in non-pregnant women after one elective CS was affected by the site of the uterine incision, uterine flexion, maternal age, and fetal birth weight.

Material and methods: 208 non-pregnant women were invited for participation in the study, but only 101 of them met inclusion criteria. Standardized scar parameters (residual myometrial thickness (RMT), depth (D) and width (W) of the hypoechoic niche) were measured using ultrasonography at least 6 weeks after the CS.

Results: Scar defect was detected in 26 of 101 subjects. Women without scar defect had significantly higher RMT values (1.87 vs. 0.87), lower newborn birth weight (3127 g vs. 3295 g), and higher scar location above the internal cervical os (62% vs. 16%), than those with scar defect. Maternal age was significantly correlated with D value (R = 0.40). Uterine retroflexion was significantly correlated with a larger D value (R = 0.63) and a larger D/RMT ratio (R = 0.24).

Conclusions: In low-risk women who have undergone one elective CS, several risk factors are associated with development of the scar defect, but only scar location can be modified during surgery. Future research is needed to determine whether a relatively higher incision location in the uterus can ensure optimal healing of the CS scar.

Get Citation

Keywords

cesarean section scar, uterine scar, residual myometrial thickness, scar morphology, scar defect, ultrasonography, risk factors of scar defect

About this article
Title

Morphology of the cesarean section scar in the non-pregnant uterus after one elective cesarean section

Journal

Ginekologia Polska

Issue

Vol 88, No 4 (2017)

Article type

Research paper

Pages

174-179

Published online

2017-04-28

DOI

10.5603/GP.a2017.0034

Pubmed

28509317

Bibliographic record

Ginekol Pol 2017;88(4):174-179.

Keywords

cesarean section scar
uterine scar
residual myometrial thickness
scar morphology
scar defect
ultrasonography
risk factors of scar defect

Authors

Michał Pomorski
Tomasz Fuchs
Anna Rosner-Tenerowicz
Mariusz Zimmer

References (22)
  1. Spong CY, Berghella V, Wenstrom KD, et al. Preventing the first cesarean delivery: summary of a joint Eunice Kennedy Shriver National Institute of Child Health and Human Development, Society for Maternal-Fetal Medicine, and American College of Obstetricians and Gynecologists Workshop. Obstet Gynecol. 2012; 120(5): 1181–1193.
  2. Timor-Tritsch IE, Monteagudo A, Cali G, et al. Cesarean scar pregnancy and early placenta accreta share common histology. Ultrasound Obstet Gynecol. 2014; 43(4): 383–395.
  3. Caughey AB, Cahill AG, Guise JM, et al. American College of Obstetricians and Gynecologists (College), Society for Maternal-Fetal Medicine. Safe prevention of the primary cesarean delivery. Am J Obstet Gynecol. 2014; 210(3): 179–193.
  4. Boyle A, Reddy UM, Landy HJ, et al. Primary cesarean delivery in the United States. Obstet Gynecol. 2013; 122(1): 33–40.
  5. Clark EAS, Silver RM. Long-term maternal morbidity associated with repeat cesarean delivery. Am J Obstet Gynecol. 2011; 205(6 Suppl): S2–10.
  6. Timor-Tritsch IE, Monteagudo A. Unforeseen consequences of the increasing rate of cesarean deliveries: early placenta accreta and cesarean scar pregnancy. A review. Am J Obstet Gynecol. 2012; 207(1): 14–29.
  7. Pomorski M, Fuchs T, Zimmer M. Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: a prospective observational study. BMC Pregnancy Childbirth. 2014; 14: 365.
  8. Valentin L. Prediction of scar integrity and vaginal birth after caesarean delivery. Best Pract Res Clin Obstet Gynaecol. 2013; 27(2): 285–295.
  9. Vikhareva Osser O, Valentin L. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. Obstet Gynecol. 2011; 117(3): 525–532.
  10. Varner M. Cesarean scar imaging and prediction of subsequent obstetric complications. Clin Obstet Gynecol. 2012; 55(4): 988–996.
  11. Wang CB, Chiu WW, Lee CY, et al. Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol. 2009; 34(1): 85–89.
  12. Yazicioglu F, Gökdogan A, Kelekci S, et al. Incomplete healing of the uterine incision after caesarean section: Is it preventable? Eur J Obstet Gynecol Reprod Biol. 2006; 124(1): 32–36.
  13. Vikhareva Osser O, Valentin L. Risk factors for incomplete healing of the uterine incision after caesarean section. BJOG. 2010; 117(9): 1119–1126.
  14. Ofili-Yebovi D, Ben-Nagi J, Sawyer E, et al. Deficient lower-segment Cesarean section scars: prevalence and risk factors. Ultrasound Obstet Gynecol. 2008; 31(1): 72–77.
  15. Zimmer M, Pomorski M, Fuchs T, et al. Ultrasonographic analysis of cesarean scars features in nonpregnant uterus. Ginekol Pol. 2007; 78(11): 842–846.
  16. Bij de Vaate AJM, van der Voet LF, Naji O, et al. Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review. Ultrasound Obstet Gynecol. 2014; 43(4): 372–382.
  17. Naji O, Abdallah Y, Bij De Vaate AJ, et al. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol. 2012; 39(3): 252–259.
  18. Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol. 2009; 34(1): 90–97.
  19. Vervoort A, Uittenbogaard LB, Hehenkamp W, et al. Why do niches develop in Caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015: dev240.
  20. Zimmer EZ, Bardin R, Tamir A, et al. Sonographic imaging of cervical scars after Cesarean section. Ultrasound Obstet Gynecol. 2004; 23(6): 594–598.
  21. van der Voet LF, Bij de Vaate AM, Veersema S, et al. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014; 121(2): 236–244.
  22. Naji O, Daemen A, Smith A, et al. Changes in Cesarean section scar dimensions during pregnancy: a prospective longitudinal study. Ultrasound Obstet Gynecol. 2013; 41(5): 556–562.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl