Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study
Abstract Background Transverse uterine fundal incision (TUFI) is a beneficial procedure for mothers and babies at risk due to placenta previa-accreta, and has been implemented worldwide. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. We therefore evaluated the TU...
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| Format: | Article |
| Language: | English |
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BMC
2024-04-01
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| Series: | BMC Pregnancy and Childbirth |
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| Online Access: | https://doi.org/10.1186/s12884-024-06446-7 |
| _version_ | 1827276903458799616 |
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| author | Fumikazu Kotsuji Takashi Shibata Satoshi Nakago Hiroki Kato Sayoko Hosono Yasunori Fukuoka Koji Nishijima |
| author_facet | Fumikazu Kotsuji Takashi Shibata Satoshi Nakago Hiroki Kato Sayoko Hosono Yasunori Fukuoka Koji Nishijima |
| author_sort | Fumikazu Kotsuji |
| collection | DOAJ |
| description | Abstract Background Transverse uterine fundal incision (TUFI) is a beneficial procedure for mothers and babies at risk due to placenta previa-accreta, and has been implemented worldwide. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. We therefore evaluated the TUFI wound scar to determine the approval criteria for pregnancy after this surgery. Methods Between April 2012 and August 2022, we performed TUFI on 150 women. Among 132 of the 150 women whose uteruses were preserved after TUFI, 84 women wished to conceive again. The wound healing status, scar thickness, and resumption of blood flow were evaluated in these women by magnetic resonance imaging (MRI) and sonohysterogram at 12 months postoperatively. Furthermore, TUFI scars were directly observed during the Cesarean sections in women who subsequently conceived. Results Twelve women were lost to follow-up and one conceived before the evaluation, therefore 71 cases were analyzed. MRI scans revealed that the “scar thickness”, the thinnest part of the scar compared with the normal surrounding area, was ≥ 50% in all cases. The TUFI scars were enhanced in dynamic contrast-enhanced MRI except for four women. However, the scar thickness in these four patients was greater than 80%. Twenty-three of the 71 women conceived after TUFI and delivered live babies without notable problems until August 2022. Their MRI scans before pregnancy revealed scar thicknesses of 50–69% in two cases and ≥ 70% in the remaining 21 cases. And resumption of blood flow was confirmed in all patients except two cases whose scar thickness ≥ 90%. No evidence of scar healing failure was detected at subsequent Cesarean sections, but partial thinning was found in two patients whose scar thicknesses were 50–69%. In one woman who conceived seven months after TUFI and before the evaluation, uterine rupture occurred at 26 weeks of gestation. Conclusions Certain criteria, including an appropriate suture method, delayed conception for at least 12 months, evaluation of the TUFI scar at 12 months postoperatively, and cautious postoperative management, must all be met in order to approve a post-TUFI pregnancy. Possible scar condition criteria for permitting a subsequent pregnancy could include the scar thickness being ≥ 70% of the surrounding area on MRI scans, at least partially resumed blood flow, and no abnormalities on the sonohysterogram. Trial registration Retrospectively registered. |
| first_indexed | 2024-04-24T07:10:48Z |
| format | Article |
| id | doaj.art-72feea6ca0ca48afaaab6090b4b2061a |
| institution | Directory Open Access Journal |
| issn | 1471-2393 |
| language | English |
| last_indexed | 2024-04-24T07:10:48Z |
| publishDate | 2024-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pregnancy and Childbirth |
| spelling | doaj.art-72feea6ca0ca48afaaab6090b4b2061a2024-04-21T11:33:24ZengBMCBMC Pregnancy and Childbirth1471-23932024-04-0124111110.1186/s12884-024-06446-7Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective studyFumikazu Kotsuji0Takashi Shibata1Satoshi Nakago2Hiroki Kato3Sayoko Hosono4Yasunori Fukuoka5Koji Nishijima6Department of Obstetrics and Gynecology, Takatsuki General HospitalDepartment of Obstetrics and Gynecology, Takatsuki General HospitalDepartment of Obstetrics and Gynecology, Takatsuki General HospitalDepartment of Obstetrics and Gynecology, Takatsuki General HospitalDepartment of Obstetrics and Gynecology, Takatsuki General HospitalDepartment of Obstetrics and Gynecology, Takatsuki General HospitalCenter for Perinatal, Maternal and Neonatal Medicine, Niigata University Medical and Dental HospitalAbstract Background Transverse uterine fundal incision (TUFI) is a beneficial procedure for mothers and babies at risk due to placenta previa-accreta, and has been implemented worldwide. However, the risk of uterine rupture during a subsequent pregnancy remains unclear. We therefore evaluated the TUFI wound scar to determine the approval criteria for pregnancy after this surgery. Methods Between April 2012 and August 2022, we performed TUFI on 150 women. Among 132 of the 150 women whose uteruses were preserved after TUFI, 84 women wished to conceive again. The wound healing status, scar thickness, and resumption of blood flow were evaluated in these women by magnetic resonance imaging (MRI) and sonohysterogram at 12 months postoperatively. Furthermore, TUFI scars were directly observed during the Cesarean sections in women who subsequently conceived. Results Twelve women were lost to follow-up and one conceived before the evaluation, therefore 71 cases were analyzed. MRI scans revealed that the “scar thickness”, the thinnest part of the scar compared with the normal surrounding area, was ≥ 50% in all cases. The TUFI scars were enhanced in dynamic contrast-enhanced MRI except for four women. However, the scar thickness in these four patients was greater than 80%. Twenty-three of the 71 women conceived after TUFI and delivered live babies without notable problems until August 2022. Their MRI scans before pregnancy revealed scar thicknesses of 50–69% in two cases and ≥ 70% in the remaining 21 cases. And resumption of blood flow was confirmed in all patients except two cases whose scar thickness ≥ 90%. No evidence of scar healing failure was detected at subsequent Cesarean sections, but partial thinning was found in two patients whose scar thicknesses were 50–69%. In one woman who conceived seven months after TUFI and before the evaluation, uterine rupture occurred at 26 weeks of gestation. Conclusions Certain criteria, including an appropriate suture method, delayed conception for at least 12 months, evaluation of the TUFI scar at 12 months postoperatively, and cautious postoperative management, must all be met in order to approve a post-TUFI pregnancy. Possible scar condition criteria for permitting a subsequent pregnancy could include the scar thickness being ≥ 70% of the surrounding area on MRI scans, at least partially resumed blood flow, and no abnormalities on the sonohysterogram. Trial registration Retrospectively registered.https://doi.org/10.1186/s12884-024-06446-7Cesarean sectionPostoperative pregnancyObstetricsTransverse uterine fundal incisionUterine ruptureWound scar |
| spellingShingle | Fumikazu Kotsuji Takashi Shibata Satoshi Nakago Hiroki Kato Sayoko Hosono Yasunori Fukuoka Koji Nishijima Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study BMC Pregnancy and Childbirth Cesarean section Postoperative pregnancy Obstetrics Transverse uterine fundal incision Uterine rupture Wound scar |
| title | Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study |
| title_full | Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study |
| title_fullStr | Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study |
| title_full_unstemmed | Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study |
| title_short | Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study |
| title_sort | evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy a ten year single center retrospective study |
| topic | Cesarean section Postoperative pregnancy Obstetrics Transverse uterine fundal incision Uterine rupture Wound scar |
| url | https://doi.org/10.1186/s12884-024-06446-7 |
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