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Obstetrics & Gynecology 2007;110:808-813
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL ARTICLES

Ultrasound Evaluation of the Uterine Scar After Cesarean Delivery

A Randomized Controlled Trial of One- and Two-Layer Closure

Benjamin D. Hamar, MD1, Shelley B. Saber, MD1, Michael Cackovic, MD1, Lissa K. Magloire, MD1, Christian M. Pettker, MD1, Sonya S. Abdel-Razeq, MD1, Victor A. Rosenberg, MD1, Irina A. Buhimschi1 and Catalin S. Buhimschi, MD1

From the 1Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, New Haven, Connecticut.

ABSTRACT

OBJECTIVE: To survey the uterine scar thickness by ultrasonography in women randomly assigned to one- or two-layer hysterotomy closure after primary cesarean delivery.

METHODS: This was a randomized, blinded trial of uterine scar closure with ultrasonographic follow-up. Thirty consecutive patients undergoing primary cesarean delivery were enrolled and randomly assigned to one- or two-layer closure of the hysterotomy. Ultrasound surveillance of the uterine scar thickness was performed at baseline (before surgery) and 48 hours, 2 weeks, and 6 weeks post partum.

RESULTS: Patient compliance with the postpartum surveillance protocol was 90%, and the uterine scar was visualized in 99% of attempted ultrasonographic examinations. There were no differences between groups at baseline or at any of the follow-up evaluations. An initial 5- to 6-fold increase in uterine scar thickness was observed, followed by a gradual decrease with the 6-week measurements still thicker than baseline. Repeated measures analysis of variance showed significant variation across time points starting either at baseline (P<.001) or at 48 hour postoperatively (P<.001), but this variation did not depend on closure type (P=.79 for all visits and P=.81 beginning with 48-hour postoperative time point).

CONCLUSION: The process of uterine scar remodeling can be successfully monitored by ultrasonography. Uterine scar thickness diminishes progressively after both one- or two-layer closure but does not vary with mode of hysterotomy closure. The uterine scar thickness remains increased even at 6 weeks post partum, suggesting that the process of uterine scar remodeling extends beyond the traditional postpartum period.

CLINCAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT00224250

LEVEL OF EVIDENCE: I




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O. Ceci, M. Scioscia, S. Bettocchi, C. Cantatore, C. Nardelli, A. Laera, and A. Vimercati
Ultrasound Evaluation of the Uterine Scar After Cesarean Delivery: A Randomized Controlled Trial of One- and Two-Layer Closure
Obstet. Gynecol., February 1, 2008; 111(2): 452 - 452.
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