Ultrasound evaluation of uterine healing after vaginal repair of cesarean section scar defect: An observational study✰.

OBJECTIVES

To evaluate the association between uterine healing and uterine artery blood flow changes after vaginal repair of cesarean section scar defects (CSDs) with two-dimensional power Doppler ultrasound and Doppler velocimetry.

STUDY

DESIGN

A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 98 women with CSDs underwent vaginal repair (VR), between June 2021 and March 2022. During follow up 9 patients withdrew from the study. After VR, all patients were followed by Doppler ultrasound scanning at 2 days, 1 month and 3 months postoperatively. The size and location of the CSDs, The thickness of the residual myometrium (TRM) and Doppler velocimetry of the uterine arteries were evaluated.

RESULTS

TRM was significantly improved after vaginal repair (P < 0.05). There was a significant (P < 0.05) progressive reduction in the uterine scar area from 82% on the second day in the first month to 67% in the third month. The pulsation index (PI), resistance index (RI), and systolic peak flow rate/diastolic flow rate (S/D) of the uterine artery showed little change after vaginal repair. The peak systolic velocity (PSV) value of the uterine artery significantly increased from 50.35 preoperatively to 53.92 on the second day after repair (p = 0.006). According to the preoperative duration of menstruation, the patients were divided into two groups (menstruation duration ≤ 7 days group and menstruation duration >7 days group). The PSV values of the uterine artery in the first postoperative month were 53.32 ± 8.49 and 48.24 ± 7.35, respectively, and there was a significant difference between the two groups (p = 0.028).

CONCLUSIONS

The TRMs of CSD patients can be improved by vaginal repair. Traditional two-dimensional ultrasound and Doppler velocimetry can dynamically assess the healing process of the uterus after vaginal repair. Moreover, the PSV value in the first month after surgery may be a marker for predicting wound healing.