title: Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography.
abstract: OBJECTIVE
  Ultrasound examination is an objective method for assessment of uterine scar defects. The present study was conducted to compare single-layer interrupted sutures (Group A) with double-layer interrupted sutures (Group B) and our new method (Group C) as well as other perioperative parameters in relation to risk of wedge defects in scars.
  
  
  METHODS
  We have introduced a new myometrium closure procedure consisting of continuous suture with decidual closure followed by interrupted myometrium suture. In this prospective study, women undergoing cesarean operation (n = 137) were examined by transvaginal ultrasound one month after surgery to assess the appearance of lower uterine scars. Multivariate logistic regression analysis was performed to identify associations of perioperative parameters and methods for lower myometrium closure with abnormal wedge formation.
  
  
  RESULTS
  Wedge defects were observed in a total of 27 patients (19.7%). The analysis revealed Groups B and C to have reduced risks with odds ratios of 0.28 and 0.077, respectively, as compared to Group A. Furthermore, increasing gestational week at delivery, plural fetal pregnancies, premature rupture of membranes and pre-eclampsia were also linked with an increased risk, with odds ratios of 1.4-8.9.
  
  
  CONCLUSIONS
  The incidence of uterine scar defects 1 month after cesarean sections varies with the method applied for myometrial suture and perioperative variables. The data suggest that methods for myometrium closure as well as other factors influence the condition of myometrial healing.
authors.affiliation: Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Japan.
authors.forename: Hiromi
authors.initials: H
authors.lastname: Hayakawa
authors.forename: Atsuo
authors.initials: A
authors.lastname: Itakura
authors.forename: Takashi
authors.initials: T
authors.lastname: Mitsui
authors.forename: Mayumi
authors.initials: M
authors.lastname: Okada
authors.forename: Masaki
authors.initials: M
authors.lastname: Suzuki
authors.forename: Koji
authors.initials: K
authors.lastname: Tamakoshi
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Kikkawa
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D009215:Myometrium / Q000000981:diagnostic imaging / Q000601:surgery*; D016017:Odds Ratio; D011183:Postoperative Complications; D011247:Pregnancy; D012307:Risk Factors; D013536:Suture Techniques; D016896:Treatment Outcome; D014463:Ultrasonography; D014621:Vagina / Q000000981:diagnostic imaging; D014945:Wound Healing