Does the appearance of the cutaneous scar after cesarean section reflect the residual myometrial thickness?
Cesarean section
Manchester scar scale
Residual myometrial thickness
Ultrasound
Journal
Archives of gynecology and obstetrics
ISSN: 1432-0711
Titre abrégé: Arch Gynecol Obstet
Pays: Germany
ID NLM: 8710213
Informations de publication
Date de publication:
03 2021
03 2021
Historique:
received:
26
10
2020
accepted:
15
12
2020
pubmed:
9
1
2021
medline:
1
4
2021
entrez:
8
1
2021
Statut:
ppublish
Résumé
The aim of this study is to utilize the Manchester scar scale (MSS) and ultrasound in investigating the association between uterine wall defects and cutaneous scar characteristics after cesarean section (CS). This is a prospective cohort study. The degree of myometrial loss was quantified by calculating a residual myometrial thickness (RMT) ratio as a percentage of RMT to the pre-cesarean anterior uterine wall thickness. Cutaneous scar assessment was performed according to the MSS. Spearman's correlation and the Kruskal-Wallis test with a cut-off value of p < 0.05 were used for statistical analysis. Two hundred forty seven women, of which 2.4% had an Asian, 3.6% an Afro-American, 82% a Caucasian and 12% a Mediterranean background, were recruited. The RMT ratio ranged between 11.9 and 100% with a median of 55.8% and an average of 56%. MSS scores ranged from 4 to 13 with a median of 5 and an average of 6. Spearman's correlation between MSS and RMT ratio show a rho of - 0.01 with a p value of 0.8. The correlation between MSS and RMT ratio within the four ethnical groups showed a p value between 0.3 and 0.8 and a rho between 0.8 and - 0.8. The Kruskal-Wallis test showed an eta CS laparotomy scars heal differently between ethnical groups, but generally with satisfying results. Ethnicity does not affect myometrial healing and scar appearance does not reflect myometrial healing after CS. Thus, separate uterine sonographic assessment is recommended.
Identifiants
pubmed: 33415438
doi: 10.1007/s00404-020-05943-2
pii: 10.1007/s00404-020-05943-2
pmc: PMC7960579
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
847-851Références
Betran AP, Ye J, Moller A-B, Zhang J, Gulmezoglu AM, Torloni MR (2016) The Increasing trend in caesarean section rates: global, regional and national estimates: 1990–2014. (Report). PLoS ONE 11:2. https://doi.org/10.1371/journal.pone.0148343
doi: 10.1371/journal.pone.0148343
Cromi A, Ghezzi F, Gottardi A, Cherubino M, Uccella S, Valdatta L (2010) Cosmetic outcomes of various skin closure methods following cesarean delivery: a randomized trial. Am J Obstet Gynecol 203(1):36.e31-36.e38. https://doi.org/10.1016/j.ajog.2010.02.001
doi: 10.1016/j.ajog.2010.02.001
Brown BC, McKenna SP, Siddhi K, McGrouther DA, Bayat A (2008) The hidden cost of skin scars: quality of life after skin scarring. J PlastReconstrAesthetSurg 61(9):1049–1058. https://doi.org/10.1016/j.bjps.2008.03.020
doi: 10.1016/j.bjps.2008.03.020
Mackeen AD, Fleisher J, Khalifeh A, Pettker CM, Berghella V (2014) Patient satisfaction and cosmetic outcome in a randomized study of cesarean skin closure. ObstetrGynecol (NY 1953) 123(Suppl 1):4S-5S. https://doi.org/10.1097/01.AOG.0000447248.54066.04
doi: 10.1097/01.AOG.0000447248.54066.04
Beausang E, Floyd H, Dunn KW, Orton CI, Ferguson MWJ (1998) A new quantitative scale for clinical scar assessment. PlastReconstrSurg 102(6):1954–1961. https://doi.org/10.1097/00006534-199811000-00022
doi: 10.1097/00006534-199811000-00022
VikharevaOsser O, Jokubkiene L, Valentin L (2009) High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound ObstGyn 34(1):90–97. https://doi.org/10.1002/uog.6395
doi: 10.1002/uog.6395
Wang H-Y, Jiang Q, Shi H, Xu Y-Q, Shi A-C, Sun Y-L, Li J, Ning Q, Shen G-X (2016) Effect of caesarean section on maternal and foetal outcomes in acute fatty liver of pregnancy: a systematic review and meta-analysis. Scie Rep (Nat Publ Group) 6(1):28826. https://doi.org/10.1038/srep28826
doi: 10.1038/srep28826
Thurmond AS, Harvey WJ, Smith SA (1999) Cesarean section scar as a cause of abnormal vaginal bleeding: diagnosis by sonohysterography. J Ultras Med 18(1):13–16. https://doi.org/10.7863/jum.1999.18.1.13
doi: 10.7863/jum.1999.18.1.13
Jordans I, De Leeuw R, Stegwee S, Amso N, Barri-Soldevila P, Van Den Bosch T, Bourne T, Brölmann H, Donnez O, Dueholm M (2019) Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure. Ultrasound Obstet Gynecol 53(1):107–115
doi: 10.1002/uog.19049
Brochhausen C, Schmitt VH, Planck CN, Rajab TK, Hollemann D, Tapprich C, Krämer B, Wallwiener C, Hierlemann H, Zehbe R, Planck H, Kirkpatrick CJ (2012) Current strategies and future perspectives for intraperitoneal adhesion prevention. J GastrointestSurg 16(6):1256–1274. https://doi.org/10.1007/s11605-011-1819-9
doi: 10.1007/s11605-011-1819-9
Dogan NU, Haktankacmaz SA, Dogan S, Ozkan O, Celik H, Eryilmaz OG, Doganay M, Gulerman C (2011) A reliable way to predict intraabdominal adhesions at repeat cesarean delivery: scar characteristics. Acta Obstet GynecolScand 90(5):531–534. https://doi.org/10.1111/j.1600-0412.2011.01080.x
doi: 10.1111/j.1600-0412.2011.01080.x
Al Naimi A, Mouzakiti N, Hondrich M, Louwen F, Bahlmann F (2020) The B-mode sonographic evaluation of the post-caesarean uterine wall and its methodology: a study protocol. J Obstet Gynaecol Res. https://doi.org/10.1111/jog.14492
doi: 10.1111/jog.14492
pubmed: 33094538
Seliger G, Muendane A, Chaoui K, Hiller GGR, Lautenschläger C, Costa S-D, Tchirikov M (2018) Does ultrasound-guided intervention during repeat cesarean sections improve uterine scar architecture and reduce the number of scars? A prospective controlled clinical intervention trial. J Perinat Med 46(8):857. https://doi.org/10.1515/jpm-2017-0394
doi: 10.1515/jpm-2017-0394
pubmed: 29570454
Tully L, Gates S, Brocklehurst P, McKenzie-McHarg K, Ayers S (2002) Surgical techniques used during caesarean section operations: results of a national survey of practice in the UK. Eur J Obstet Gyn R B 102(2):120–126. https://doi.org/10.1016/S0301-2115(01)00589-9
doi: 10.1016/S0301-2115(01)00589-9
Sandy-Hodgetts K, Parsons R, Norman R, Fear MW, Wood FM, White SW (2020) Effectiveness of negative pressure wound therapy in the prevention of surgical wound complications in the cesarean section at-risk population: a parallel group randomised multicentre trial-the CYGNUS protocol. BMJ Open 10(10):e035727. https://doi.org/10.1136/bmjopen-2019-035727
doi: 10.1136/bmjopen-2019-035727
pubmed: 33077559
pmcid: 7574944
van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP (2005) Reliable and feasible evaluation of linear scars by the patient and observer scar assessment Scale. PlastReconstrSurg 116(2):514–522. https://doi.org/10.1097/01.prs.0000172982.43599.d6
doi: 10.1097/01.prs.0000172982.43599.d6
Owji N, Khademi B, Khalili MR (2018) Effectiveness of topical onion extract gel in the cosmetic appearance of blepharoplasty scar. J ClinAesthetDermatol 11(10):31–35
Baranov A, Salvesen KÅ, Vikhareva O (2017) Assessment of cesarean hysterotomy scar before pregnancy and at 11–14 weeks of gestation: a prospective cohort study. Ultrasound Obstet Gynecol 50(1):105–109
doi: 10.1002/uog.16220
Bielefeld KA, Amini-Nik S, Alman BA (2013) Cutaneous wound healing: recruiting developmental pathways for regeneration. Cell Mol Life Sci 70(12):2059–2081. https://doi.org/10.1007/s00018-012-1152-9
doi: 10.1007/s00018-012-1152-9
pubmed: 23052205
Gallant-Behm CL, Olson ME, Hart DA (2005) Cytokine and growth factor mRNA expression patterns associated with the hypercontracted, hyperpigmented healing phenotype of red duroc pigs: a model of abnormal human scar development? J Cutan Med Surg 9(4):165–177. https://doi.org/10.1007/s10227-005-0105-4
doi: 10.1007/s10227-005-0105-4
pubmed: 16502202
Lofrumento DD, Di Nardo MA, De Falco M, Di Lieto A (2017) Uterine wound healing: a complex process mediated by proteins and peptides. Curr Protein Pept Sci 18(2):125–128. https://doi.org/10.2174/1389203717666160322145939
doi: 10.2174/1389203717666160322145939
pubmed: 27001064
Kokanalı D, Kokanalı MK, Topcu HO, Ersak B, Tascı Y (2019) Are the cesarean section skin scar characteristics associated with intraabdominal adhesions located at surgical and non-surgical sites. J Gynecol Obstet Hum 48(10):839–843. https://doi.org/10.1016/j.jogoh.2019.03.026
doi: 10.1016/j.jogoh.2019.03.026
Madu P, Kundu RV (2014) Follicular and scarring disorders in skin of color: presentation and management. Am J ClinDermatol 15(4):307–321. https://doi.org/10.1007/s40257-014-0072-x
doi: 10.1007/s40257-014-0072-x
Bayat A, McGrouther DA, Ferguson MW (2003) Skin scarring. BMJ 326(7380):88–92. https://doi.org/10.1136/bmj.326.7380.88
doi: 10.1136/bmj.326.7380.88
pubmed: 1125033
pmcid: 1125033