Incomplete healing of the uterine incision after cesarean section: is it preventable by intraoperative digital dilatation of the internal cervical ostium?

Abstract

Background/aims: It was the aim of this study to determine if intraoperative digital dilatation of the closed internal cervical ostium affects the healing of the uterine scar after a cesarean section (CS).

Methods: In this randomized, prospective study, 94 term pregnant patients who elected to have a CS were assigned to two groups: intraoperative digital dilatation of the internal cervical ostium (group I, n = 48) or no dilatation (group II, n = 46). Vaginal ultrasound was used to check the integrity of the cesarean scar at the uterine incision site 40-42 days after the operation. We calculated the healing ratio based on ultrasonographic results and compared the groups as to the amount of incomplete healing.

Results: The frequency of abnormal scarring was significantly higher in group II (14.3 vs. 40.6%; p < 0.05). The mean healing ratio was significantly higher in group I (0.95 ± 0.12) than in group II (0.87 ± 0.1; p < 0.05). In the multiple logistic regression model, digital dilatation remained the most significant factor affecting abnormal scar formation (odds ratio = 7.7).

Conclusion: Digital dilatation of a closed cervix in elective CS might lower the incidence of abnormal scarring of the uterine incision.