Tekiner Nur Betül, Çetin Berna Aslan, Türkgeldi Lale Susan, Yılmaz Gökçe, Polat İbrahim, Gedikbaşı Ali
Obstetrics and Gynecology Department, İstanbul Beykoz State Hospital, Istanbul, Turkey.
Department of Obstetrics and Gynecology, İstanbul Kanuni Sultan Süleyman Training and Research Hospital, Altınşehir, 34303, Halkalı, İstanbul, Turkey.
Arch Gynecol Obstet. 2018 May;297(5):1137-1143. doi: 10.1007/s00404-018-4702-z. Epub 2018 Feb 3.
We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single- or double-layered unlocked closure of their uterine incision during their first cesarean delivery.
This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section. Patients with a previous history of cesarean delivery, preterm pregnancies less than 34 gestational weeks, patients lost to follow-up or those who had an IUD inserted after delivery were excluded from the study. Out of the 327 patients who underwent primary cesarean delivery, 280 were included into the study. Patients were divided into two groups according to the single- (n:126) or double-layered (n:156) closure of their uterine incision. The maternal age, height, weight, obstetric and gynecologic histories, medical histories, indications for their cesarean delivery, technique of uterine closure, birth weight of the baby, duration of the cesarean delivery, need for extra suturing and transfusion were recorded. A Saline infusion sonography (SIS) was performed 3 months postoperatively to determine the presence, depth and length of the cesarean scar. The residual myometrial thickness overlying the scar defect and the fundal myometrial thickness were recorded.
No difference was detected between the groups with respect to patient characteristics, whether the operation was elective or emergent, the type of anesthesia used, need for extra suturing, incidence of bladder injuries or uterine atony, need for blood transfusions, duration of labour or cervical dilatation and effacement between the two groups. No statistically significant difference was detected between the two groups with respect to the length and depth of the scar defect.
Single- or double-layered closure of the uterus does not seem to affect the size of the uterine scar defect detected on SIS 3 months following the first cesarean delivery.
我们旨在确定在首次剖宫产时采用单层或双层非锁定子宫切口缝合的患者中，术后第三个月使用生理盐水灌注超声检查（SIS）测量的剖宫产瘢痕缺损大小是否存在差异。
本研究为前瞻性横断面研究，于2015年2月至2016年1月在卡努尼·苏莱曼培训与研究医院产科病房收治的、随后首次行剖宫产分娩的患者中进行。既往有剖宫产史、孕周小于34周的早产患者、失访患者或产后放置宫内节育器的患者被排除在研究之外。在327例行初次剖宫产的患者中，280例纳入研究。根据子宫切口单层缝合（n = 126）或双层缝合（n = 156）将患者分为两组。记录产妇的年龄、身高、体重、妇产科病史、内科病史、剖宫产指征、子宫缝合技术、婴儿出生体重、剖宫产持续时间、是否需要额外缝合及输血情况。术后3个月进行生理盐水灌注超声检查（SIS），以确定剖宫产瘢痕的存在、深度和长度。记录瘢痕缺损上方的肌层残余厚度和宫底肌层厚度。
两组在患者特征、手术是择期还是急诊、所用麻醉类型、是否需要额外缝合、膀胱损伤或子宫收缩乏力的发生率、输血需求、产程持续时间或宫颈扩张及消退情况方面均未检测到差异。两组在瘢痕缺损的长度和深度方面未检测到统计学显著差异。
子宫单层或双层缝合似乎不影响首次剖宫产术后3个月通过SIS检测到的子宫瘢痕缺损大小。
