The Study About The Healing Of Uterine Incision After Cesarean Section By Ultrasound Monitoring

Objective: Cesarean section is the effective surgical method for abnormal fetal position, fetal intrauterine hypoxia and stalled delivery, in recent years, as China’s economy continues to improve, the number of cesarean section has been gradually rising, the incident rate of poor healing of uterine incision, uterine scar diverticulum, cesarean scar pregnancy and abdominal adhesions also keep increasing, especially the cesarean scar pregnancy, the rupture hemorrhage may endanger the lives of the pregnant women. This study uses single-layer and double-layer anastomosis for the incision of the elective cesarean section and the cesarean delivery, ultrasound is applied 5 days, 42 days, 3 months and 6 months after the surgery to assess the thickness of the uterine incision scar and various diameters of the uterine, and to evaluate the healing of the uterine incision scar and uterine involution, cesarean section incision anastomosis is the preferable method to reduce the incidence of complications after cesarean section, and provide guidance for the clinical work.Methods: Two hundreds pregnant women were divided into two equal group, the elective cesarean section group and the cesarean delivery group, single-layer and double-layer anastomosis are applied to suture the cesarean incision of the lower uterine segment, both methods are applied to 50 participants in each group. Ultrasound is performed on the abdomen 5 days, 42 days, 3 months and 6 months after the surgery, to measure the thickness of the uterine scar, the length, transverse diameter and anteroposterior diameter of the uterine, compare the differences and evaluate the healing status of the uterine cesarean incision and the uterine involution. Review on the women with the second cesarean section in the Zaoqiang County People’s Hospital, there are 298 cases single layer suture in the control group and 319 cases double layer suture in the observation group.explore the connection between the pelvic adhesion and the anastomosis method in the primary cesarean section.Results: 1 Comparison of the number of cases with uterine incision healing 1.1 In-group comparison of the cesarean section scar’s healing 1.1.1 In-group comparison among the elective cesarean section with single-layer anastomosis group, the elective cesarean section with double-layer anastomosis, cesarean delivery with single-layer anastomosis and cesarean delivery with double-layer anastomosis, significant differences were observed in the healing of the uterine incision scar 5 days and 42 days after the surgery(P<0.05); there is no significant differences among the healing status of the uterine incision scar 42 days, 3 months and 6 months after the surgery(P >0.05). 1.2 Cross-group comparison on the healing of scar in different period after surgery 1.2.1 Five days after the surgery, the thickness of the uterine incision in elective cesarean section with single-layer anastomosis elective cesarean section with double-layer anastomosis, cesarean delivery with single-layer anastomosis cesarean delivery with double-layer anastomosis, elective cesarean section with single-layer anastomosis cesarean delivery with single-layer anastomosis and elective cesarean section with double-layer anastomosis cesarean delivery with double-layer anastomosis has no significant differences(P >0.05). 1.2.2 Forty-two days after the surgery, significant difference(P <0.05) was observed in the thickness of the uterine incision in elective cesarean section with single-layer anastomosis elective cesarean section with double-layer anastomosis, cesarean delivery with single-layer anastomosis cesarean delivery with double-layer anastomosis group; no significant difference(P >0.05) was found in the elective cesarean section with single-layer anastomosis cesarean delivery with single-layer anastomosis and elective cesarean section with double-layer anastomosis cesarean delivery with double-layer anastomosis group. 1.2.3 Tree months after the surgery, the thickness of the uterine incision in elective cesarean section with single-layer anastomosis elective cesarean section with double-layer anastomosis, cesarean delivery with single-layer anastomosis cesarean delivery with double-layer anastomosis, elective cesarean section with single-layer anastomosis cesarean delivery with single-layer anastomosis and elective cesarean section with double-layer anastomosis cesarean delivery with double-layer anastomosis has no significant differences(P >0.05). 1.2.4 Six months after the surgery, the thickness of the uterine incision in elective cesarean section with single-layer anastomosis elective cesarean section with double-layer anastomosis, cesarean delivery with single-layer anastomosis cesarean delivery with double-layer anastomosis, elective cesarean section with single-layer anastomosis cesarean delivery with single-layer anastomosis and elective cesarean section with double-layer anastomosis cesarean delivery with double-layer anastomosis has no significant differences(P >0.05). 2 Comparison of the number of cases with poor healing of uterine incision 2.1 Five days after the surgery, the ultrasound indicated no occurrence of poor healing of the uterine incision in both group A and B. 42 days after the surgery, echo inequality on uterine muscle is noticed in ultrasound, alone with hyperechoic spot and echo of small dark area, including 3 cases in group A1, 1 case in group A2, 4 cases in group B1, there was no occurrence of poor healing of uterine incisionin group B2, no significant differences were found in elective cesarean section with single-layer anastomosis elective cesarean section with double-layer anastomosis, cesarean delivery with single-layer anastomosis cesarean delivery with double-layer anastomosis, elective cesarean section with single-layer anastomosis cesarean delivery with single-layer anastomosis and elective cesarean section with double-layer anastomosis cesarean delivery with double-layer anastomosis, there was no statistical significance(P >0.05).(See Table 6, Table 7). Echo inequality on uterine muscle, hyperechoic spot and echo of small dark area were noticed in ultrasound 3 months and 6 months after surgery in 1 case in group B1, abnormalities were not found in other groups. 3 Comparison of the number of cases with uterine involution after cesarean section3.1 In-group comparison on uterine involution in different period of time after cesarean section 3.1.1 In-group comparison in uterine involution 5 days and 42 days after surgery among the elective cesarean section with single-layer anastomosis, the elective cesarean section with double-layer anastomosis, the cesarean delivery with single-layer anastomosis and the cesarean delivery with double-layer anastomosis indicated significant difference(P <0.05). 3.2 Cross-group comparison on uterine involution in different period of time after cesarean section 3.2.1 Cross-group comparison in uterine involution 5 days after surgery among the elective cesarean section with single-layer anastomosis, the elective cesarean section with double-layer anastomosis, the cesarean delivery with single-layer anastomosis and the cesarean delivery with double-layer anastomosis indicated significant difference(P <0.05). 3.2.2 Comparison in uterine involution 42 days, 3 months and 6 months after surgery among the elective cesarean section with single-layer anastomosis, the elective cesarean section with double-layer anastomosis, the cesarean delivery with single-layer anastomosis and the cesarean delivery with double-layer anastomosis indicated significant difference(P <0.05). 4 Comparison of the number of cases with poor uterine involution after cesarean section 4.1 Ultrasound 5 days after the surgery indicated that the sum of three diameters is less than 35 cm in all puerpera, and are all in the normal range. Ultrasound 42 days after the surgery indicated the sum of three diameters is more than 16 cm with occurrence of poor uterine involution, including 13 cases in group A1, 4 cases in group A2, 14 cases in group B1, 3 cases in group B2, there were significant differences(P <0.05) in the comparison in elective cesarean section with single-layer anastomosis the elective cesarean section with double-layer anastomosis, and the cesarean delivery with single-layer anastomosis the cesarean delivery with double-layer anastomosis respectively.(See Table 8, Table 9) 4.2 Forty-two days after the surgery, the ultrasound indicated that after anti-inflammatory therapies and uterine contraction, ultrasound indicated the puerpera’s three diameters is more than 16 cm in 2 cases in group A1, 1 case in group A2, 5 cases in group B1, no occurrence of poor uterine involution in group B2; the results of ultrasound taken 6 months after the surgery is same as the ultrasound results taken 3 months after the surgery, no significant differences(P >0.05) were observed in the elective cesarean section with single-layer anastomosis, the elective cesarean section with double-layer anastomosis, the cesarean delivery with single-layer anastomosis and the cesarean delivery with double-layer anastomosis.(See Table 8, Table 9) 5 Connections between the intraperitoneal adhesionsis in secondary cesarean section and the uterine incision anastomosis in the primary cesarean section 5.1 Tree hundred and ninteen cases are grouped into the study group, 298 cases are grouped into the control group, the goal is to observe the intraperitoneal adhesionsis in women with secondary cesarean section. No occurrence of intraperitoneal adhesionsis was reported in 266 cases, mild adhesionsis was reported in 38 cases, the number of intermediate and severe adhesionsis were 13 and 2; In the control group, 199 cases were reported without adhesionsis, 57 were reported with mild adhesionsis, 32 and 10 were reported with intermediate and severe adhesionsis. The rank sum test indicated significant differences(P <0.01) in the severity in the study group and the control group, intraperitoneal adhesionsis more likely occurs in participants in the study group. Conclusion:1 There is no significant difference in the thickness of the uterine incision scar.2 Regardless of the elective cesarean section or the cesarean delivery, double-layer anastomosis can make it a better option in the involution of uterus, compared with the single-layer anastomosis.3 Double-layer anastomosis can reduce the pelvic adhesionsis, compared with the single-layer anastomosis.