Uterine scar defects

Abstract

This issue contains several articles relevant to uterine scar weakness or defects, and finding the optimal materials and techniques for wound strength. In August 2008 we published an editorial (MacLean & MacLean, 2008) suggesting that the transition from a two layer uterine wall closure at Caesarean section with chromic catgut to the use of polyglycolic acid or polyglactin materials may be associated with the increasing numbers of reports of uterine scar rupture and Caesarean scar pregnancies. We suggested that surgeons and in particular orthopaedic surgeons were more aware of wound strengths, and that there should be more research in Obstetrics and Gynaecology into suture materials and subsequent performance of the wounds. The article by Uppal et al (2011) from New South Wales, Australia, describes the findings at ultrasound scanning of fluid filled uterine wall defects in 29 (40%) of 71 women who had previously undergone Caesarean section. They describe that the presence of these uterine scar defects was significantly associated with prolonged menstruation or post-menstrual spotting. We are not told and they probably did not know how these Caesarean uterine wounds were repaired, but this observation, relatively recently reported, may follow a change in repair technique or suture material for the Caesarean section.