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. 2021 Aug 17;21(1):559.
doi: 10.1186/s12884-021-04040-9.

Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique

Shahul Hameed Mohamed Siraj  1 , Karuna Mary Lional  2 , Kok Hian Tan  3   4 , Ann Wright  3
Affiliations

Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique

Shahul Hameed Mohamed Siraj et al. BMC Pregnancy Childbirth. .

Abstract

Background: To investigate whether the existing surgical technique for uterine closure at repeat lower segment Caesarean section (LSCS) can be modified to achieve adequate residual myometrial thickness (RMT) to ensure scar integrity and reduce complications in future pregnancy.

Methods: Women with a significant scar defect at repeat LSCS had the anterior uterine wall closed by a single experienced obstetrician with a technique focused on recognition, mobilisation and apposition of the retracted myometrial edges at the boundary of the defect. This was aimed at anatomical restoration of the lower segment. The RMT at the scar area was assessed by postnatal pelvic ultrasound scan at three months.

Results: Thirty women with a history of at least one previous CS, incidentally found to have a large defect at operation underwent the technique with prior consent. A postnatal scan showed a mean residual myometrial thickness of 8.4 mm (SD ±1.3 mm; range 5.6-11.0 mm). The average operating time was 91 mins and the average blood loss 728 ml. Two women who underwent the repair have gone on to have a further uneventful CS.

Conclusion: This modified technique resulted in scan evidence of an RMT indicative of uterine wall stability postnatally and offers the potential for reducing the risk of rupture and placenta accreta spectrum (PAS) in future pregnancy.

Keywords: Caesarean scar dehiscence; Myometrial repair; Residual myometrial thickness.

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Conflict of interest statement

The authors have no potential conflict of interest pertaining to this study and submission.

Figures

Fig. 1
Fig. 1
Recognition of the boundaries of the myometrial defect
Fig. 2
Fig. 2
Repair of the posterior wall defect
Fig. 3
Fig. 3
Repair of the angles and anterior defect
Fig. 4
Fig. 4
Needle placement for myometrial repair. AS- Anterior superior. AI - Anterior inferior. PS- Posterior superior. PI - Posterior inferior
Fig. 5
Fig. 5
The appearance of anterior and posterior wall defect after repair. AS- Anterior superior. AI - Anterior inferior. PS- Posterior superior. PI - Posterior inferior. a continuous suture for posterior myometrial defect. b continuous suture for inner layer of anterior myometrial defect. c continuous suture for outer layer of anterior myometrial defect
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