The significance of previous uterine scar excision during the second cesarean section on prevention of previous cesarean scar diverticulum by previous uterine scar excision during the second cesarean section

Abstract

Objective To investigate the significance of previous uterine scar excision during the second cesarean section on prevention of previous cesarean scar diverticulum (PCSD). Methods One hundred and seventy-eight cases of multipara women who underwent the second cesarean section were included from January 2012 to January 2017. And they were divided into the control group and the observation group by random digital table, with 89 cases in each group. In the control group, the uterine incision was directly closed by double-layer continuous suture without any treatment to the previous scar, and in the observation group, the previous uterine cesarean scar of the patients were removed, and then the uterine incision was closed by double-layer continuous suture. The surgical related indexes of the two groups were recorded and statistically analyzed. All patients were followed up for 1 year, and the abnormal vaginal bleeding, PCSD, the residual musculocutaneous thickness of diverticulum and the volume of diverticulum were statistically analyzed in those two groups. Results There were no statistical difference between observation group and control group in operation time, intraoperative blood loss, evacuation time, the duration of postoperation bloody lochia and hospitalization time (P > 0.05). However, the abnormal vaginal bleeding [5.6% (5/89) vs. 14.6% (13/89)], the incidence of PCSD: 3.4%(3/89) vs. 12.4%(11/89), and the residual musculocutaneous thickness of diverticulum: (7.36 ± 1.66) mm vs. (4.86 ± 1.38) mm, and the volume of diverticulum: (0.37 ± 0.16) ml vs. (0.54 ± 0.15) ml in the observation group were decreased respectively, the differences were statistically significant (P < 0.05). Conclusions Excision of previous uterine scar during the second cesarean section is more beneficial for uterine section healing. It will reduce the frequency of PCSD formation, and alleviate the severity of PCSD. Key words: Cesarean section, repeat; Cicatrix; Diverticulum; Excision scar; Section healing