Effects of visceral peritoneal closure on scar formation at cesarean delivery.
OBJECTIVE
To determine the effect of closure or non-closure of the visceral peritoneum at cesarean delivery on uterine scar formation assessed at repeat cesarean delivery.


METHODS
Women undergoing initial cesarean delivery were allocated into 2 groups: group 1 underwent visceral peritoneal closure, while in group 2 the visceral peritoneum was not closed. At repeat cesarean delivery 4 specimens from the initial uterine scar were collected and assessed by light microscopy and scanning electron microscopy.


RESULTS
In group 1, 57% of women had adhesions compared with 20.6% in group 2 (P<0.05). Light microscopy revealed reactive mesothelial hyperplasia (51.8% vs 13.7%), submesothelial fibrosis (48.1% vs 6.8%), and neoangiogenesis of mesothelial stroma (44.4% vs 12%) in group 1 and group 2 patients, respectively (P<0.05). Scanning electron microscopy showed more patients with pericytes on the surface of microvessels in group 1 compared with group 2 (26.3+/-1.4 vs 11.5+/-1.1 patients; P<0.05).


CONCLUSIONS
Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions, evidenced by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis.
Malvasi
Antonio
A
Department of Obstetrics and Gynecology, Santa Maria Hospital, Bari, Italy.
Tinelli
Andrea
A
Farine
Dan
D
Rahimi
Siavash
S
Cavallotti
Carlo
C
Vergara
Daniele
D
Martignago
Roberta
R
Stark
Michael
M
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D002921:Cicatrix / Q000209:etiology / Q000473:pathology; D005260:Female; D005355:Fibrosis / Q000209:etiology / Q000473:pathology; D006801:Humans; D006965:Hyperplasia / Q000209:etiology / Q000473:pathology; D010532:Peritoneal Diseases / Q000209:etiology* / Q000473:pathology; D010537:Peritoneum / Q000473:pathology / Q000601:surgery*; D011247:Pregnancy; D013536:Suture Techniques / Q000009:adverse effects; D000267:Tissue Adhesions / Q000209:etiology / Q000473:pathology; D001745:Urinary Bladder Diseases / Q000209:etiology*; D014591:Uterine Diseases / Q000209:etiology*