Uterine scar evaluation during the postpartum: pleading for extra-decidual suturing during cesarean section.

Objective To evaluate ultrasound differences in uterine scar between techniques using extra mucosal suturing and full thickness suturing of the uterine incision. Methods A retrospective observational study included cases of primary cesarean section. At six weeks postpartum, we evaluated by endovaginal ultrasound two elements in the sagittal view: the thickness of the uterine scar and the surface of defect (niche). Hysterotomy sites closed using a running full-thickness technique including the uterine mucosa (group1) were compared to hysterotomies operated by the same surgeon but with extra mucosal suturing (group 2). The operator switched from the running suture technique to extra-mucosal in 2013. Results The study included 241 patients (115 cases in group 1 that were compared to 126 cases in group 2). There were no significant differences in age or body mass index between the two groups. Cesarean scar and niche were detectable in the entire studied population. There was a significant difference in both uterine scar thickness (5.8 mm versus 6.2 mm, p = 0,02) and the presence and size of the niche (49 mm2 versus 40 mm2 , p = 0.001) in transvaginal ultrasound performed six weeks postpartum. Conclusion Extra-mucosal suturing of the uterine scar seems to be associated with a better outcome on the postpartum ultrasound evaluation.