Risk factors for incomplete healing of the uterine incision after caesarean section.
OBJECTIVE
To determine which factors increase the risk of large caesarean scar defects as assessed by transvaginal ultrasound.


METHODS
Observational cross-sectional study.


METHODS
University Hospital.


METHODS
One hundred and eight women who had undergone one caesarean section.


METHODS
Transvaginal ultrasound examination of the scar in the uterus 6-9 months after the caesarean. Published ultrasound definitions of large scar defects were used. Clinical information was obtained from medical records after all ultrasound images had been evaluated.


METHODS
Factors increasing the risk of large caesarean scar defects.


RESULTS
Twenty-two (20%) women had a large caesarean scar defect. The odds of a large defect increased with cervical dilatation at caesarean (0 cm, 1-4 cm, 5-7 cm, 8 cm or more; odds ratio [OR] 4.4 [95% CI 0.7-28.5]; 26.5 [4.3-161.8]; and 32.4 [6.1-171.0]; P < 0.001), station of the presenting part at caesarean below pelvic inlet (OR 14.1 [4.6-43.1]; P < 0.001), duration of labour at caesarean (0 hour, 1-4 hours, 5-9 hours, 10 hours or more; OR 2.0 [0.2-23.8]; 13.0 [2.2-76.6]; and 33.1 [6.6-166.9]; P < 0.001), oxytocin augmentation (OR 6.3, [2.3-17.3]; P < 0.001), retroflexed uterus at ultrasound examination (OR 2.9 [1.0-8.3]; P = 0.047). According to multivariate logistic regression, no variable added information to cervical dilatation or the station of the presenting fetal part at caesarean.


CONCLUSIONS
Caesarean in advanced labour is associated with increased risk of incomplete healing of the uterine incision as determined by transvaginal ultrasound.
Vikhareva Osser
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Department of Obstetrics and Gynaecology, Malmö University Hospital, Lund University, Malmö, Sweden. olgavikhareva@hotmail.com
Valentin
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D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000209:etiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007747:Labor Stage, First; D007744:Obstetric Labor Complications / Q000601:surgery; D011247:Pregnancy; D012307:Risk Factors; D014463:Ultrasonography; D014599:Uterus / Q000473:pathology / Q000601:surgery*; D014945:Wound Healing; D055815:Young Adult