Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two-layer closure.
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).


CONCLUSIONS
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
Hamar
Benjamin D
BD
Yale School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Biology, New Haven, Connecticut, USA. bhamar@bidmc.harvard.edu
Saber
Shelley B
SB
Cackovic
Michael
M
Magloire
Lissa K
LK
Pettker
Christian M
CM
Abdel-Razeq
Sonya S
SS
Rosenberg
Victor A
VA
Buhimschi
Irina A
IA
Buhimschi
Catalin S
CS
D000328:Adult; D002585:Cesarean Section / Q000379:methods*; D002921:Cicatrix / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000379:methods*; D011247:Pregnancy; D011446:Prospective Studies; D013536:Suture Techniques; D014463:Ultrasonography; D014599:Uterus / Q000000981:diagnostic imaging* / Q000502:physiology; D014945:Wound Healing / Q000502:physiology