Can Cesarean Scar Defects be Prevented?

Is Isthmosel Becoming History? The Effect of Three Different Uterotomy Closure

In this study, uterotomy after cesarean section was performed using 3 different suture techniques and aimed to demonstrate the potential of the baseball suture technique to prevent the isthmusel complication known as cesarean scar defect.

An isthmocoele or cesarean scar defect is a pit-like defect in the myometrium at the isthmic level, thought to be the result of inadequate healing of the uterine incision after cesarean section. It is important not to underestimate isthmocele and to take preventive measures as it can lead to serious gynecologic and obstetric complications. However, which suturing technique is best in preventing isthmocele formation has not yet been established. The aim of this study was to compare the effects of 3 different uterine closure techniques on isthmocele formation during cesarean section.

In this study, a total of 120 term (>37 weeks) pregnant women with no previous cesarean section and scheduled for primary cesarean section will be randomized preoperatively to 3 different uterotomy closure techniques (baseball, single-lock and non-single-lock groups).

Inclusion criteria:

• Pregnant women undergoing C/S for the first time
• 37 weeks < gestation (term pregnancies)

Exclusion Criteria:

• Presence of regular contractions in the uterus
• Cervical dilatation of more than 4 cm, indicating the onset of the active phase of labour
• Placental abnormalities
• Previous uterine surgery
• Multiple pregnancy
• Premature rupture of membranes
• Chorioamnionitis
• Preoperative haemoglobin level below 10g/dl
• Body mass index (BMI) above 35kg/m2
• Any comorbidity (e.g. diabetes, hypertension, pre-eclampsia, eclampsia)
• Smoking and/or alcohol use
• The need for a blood transfusion.