The following is a summary of “Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study,” published in the April 2024 issue of Obstetrics and Gynecology by Kotsuji et al.
Transverse uterine fundal incision (TUFI) has emerged as a valuable intervention for women with placenta previa-accreta, but concerns persist regarding the risk of uterine rupture in subsequent pregnancies. To address this, the researchers conducted a comprehensive evaluation of TUFI wound scars to establish criteria for safe postoperative pregnancies. Over ten years, from April 2012 to August 2022, TUFI was performed on 150 women, with 132 preserving their uteruses. Of these, 84 expressed a desire for future conception. The study group assessed scar healing, thickness, and blood flow resumption using magnetic resonance imaging (MRI) and sonohysterogram at 12 months postoperatively.
Direct observation during subsequent Cesarean sections provided additional insights. The analysis, involving 71 cases, revealed consistent scar thickness of ≥ 50% compared to surrounding tissue on MRI scans, with enhancement in dynamic contrast-enhanced MRI, except in four cases with thicker scars (>80%). About 23 women successfully conceived post-TUFI, delivering live infants without complications. Pre-pregnancy MRI showed scar thicknesses ranging from 50–69% in two cases and ≥ 70% in 21 cases, with resumed blood flow observed in all except two cases with thicker scars (≥ 90%). No instances of scar healing failure were detected during subsequent Cesarean sections, although partial thinning was noted in two cases.
The uterine rupture occurred in one woman who conceived shortly after TUFI. The findings underscore the importance of meticulous surgical technique, deferred conception for at least 12 months, and thorough postoperative assessment in approving post-TUFI pregnancies. Proposed criteria for permitting subsequent pregnancies include scar thickness of ≥ 70% on MRI, partially restored blood flow, and absence of abnormalities on sonohysterogram. These criteria ensure safe management and optimal outcomes following TUFI.
Source: bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-024-06446-7