International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2025
Surgical repair of cesarean uterine dehiscence using a myometrial flap in fertility-preserving patients: A retrospective cohort study.
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Palacios-Jaraquemada José M, Basanta Nicolás A, Nieto-Calvache Albaro J, Huespe Miguel A, Hamer Jorge L, Gómez Estela B
Аннотация
OBJECTIVE: Uterine scar dehiscence, defined as partial myometrial disruption at a prior cesarean site with intact serosa, is increasingly diagnosed during repeat cesarean delivery. It may compromise future fertility and increase the risk of uterine rupture. Optimal surgical repair techniques that restore myometrial thickness and vascularization are crucial for preserving fertility. The aim of the present study was to describe a cohort of patients with intraoperative diagnosis of uterine dehiscence during cesarean delivery, managed with a myometrial glide flap technique to reinforce the uterine wall.
METHODS: This retrospective cohort study included 38 pregnant women with 1-4 prior cesarean deliveries who underwent cesarean section between March 2020 and March 2024. All patients desired future fertility. Dehiscence was diagnosed intra- or preoperatively via ultrasound. A myometrial flap technique was employed, involving the resection of fibrotic tissue and the mobilization of a vascularized myometrial flap to cover the defect. Postoperative healing was assessed by transvaginal ultrasound at 6 weeks and pelvic magnetic resonance imaging (MRI) at 6 months. Patients were prospectively followed to monitor their subsequent pregnancies.
RESULTS: Mean myometrial thickness at the repair site was 2.08 ± 0.26 cm (range: 1.70-2.46 cm) at 6 weeks postpartum. Of 38 patients, 31 were followed prospectively, resulting in 31 subsequent pregnancies. The mean interval to the next pregnancy was 18.7 months. All subsequent deliveries occurred by cesarean at a mean gestational age of 37.1 weeks, with no cases of uterine dehiscence or rupture. The repaired segment appeared normal intraoperatively in all cases. Mean surgical time (skin-to-skin) was 76.4 min (range: 60-95 min).
CONCLUSION: The myometrial glide flap technique effectively restores uterine wall thickness and integrity, enabling safe future pregnancies. This fertility-preserving approach may reduce long-term obstetric risks in women with prior cesarean scars.
METHODS: This retrospective cohort study included 38 pregnant women with 1-4 prior cesarean deliveries who underwent cesarean section between March 2020 and March 2024. All patients desired future fertility. Dehiscence was diagnosed intra- or preoperatively via ultrasound. A myometrial flap technique was employed, involving the resection of fibrotic tissue and the mobilization of a vascularized myometrial flap to cover the defect. Postoperative healing was assessed by transvaginal ultrasound at 6 weeks and pelvic magnetic resonance imaging (MRI) at 6 months. Patients were prospectively followed to monitor their subsequent pregnancies.
RESULTS: Mean myometrial thickness at the repair site was 2.08 ± 0.26 cm (range: 1.70-2.46 cm) at 6 weeks postpartum. Of 38 patients, 31 were followed prospectively, resulting in 31 subsequent pregnancies. The mean interval to the next pregnancy was 18.7 months. All subsequent deliveries occurred by cesarean at a mean gestational age of 37.1 weeks, with no cases of uterine dehiscence or rupture. The repaired segment appeared normal intraoperatively in all cases. Mean surgical time (skin-to-skin) was 76.4 min (range: 60-95 min).
CONCLUSION: The myometrial glide flap technique effectively restores uterine wall thickness and integrity, enabling safe future pregnancies. This fertility-preserving approach may reduce long-term obstetric risks in women with prior cesarean scars.