Scar; Previous Cesarean Section Clinical Trial
Official title:
Optimierung Der Uterotomie-Wundheilung Nach Re-Sectio Caesarea
This prospective, controlled, clinical, intervention study measures the number of uterine
Cesarean section scars and median myometrial thickness of women who underwent two Cesarean
sections six to nine months after their last Cesarean section using transvaginal ultrasound.
It is the purpose of the study to assess if a resection of the uterine scar from a previous
Cesarean section during a second Cesarean section could lead to a decrease in risk for
subsequent pregnancies.
The average number of Cesarean sections in Germany has doubled from 1991 to 2011, making up
32,1% of all deliveries in 2011.
Several studies describe instances in which pregnancies following a previous Cesarean
section were accompanied by complications such as life-threatening bleeding, placenta
previa, placenta accreta, increta or percreta and dehiscence or uterine rupture.
The risk of those complications increases further with the uterine scar tissue of a second
Cesarean section.
Today it is already common practice to resect uterine scars if the scar of a previous
Cesarean section becomes symptomatic, or when a non-symptomatic uterine rupture or serious
dehiscence are discovered during a Cesarean delivery.
In this study all participants of the interventional group are examined via intraoperative
ultrasound to identify the first uterine Cesarean section scar and resect it completely.
Six to nine months after the resection participants will return for a one time follow-up. At
this time, the investigators will measure the number of uterine scars and median myometrial
thickness using transvaginal ultrasound. The results will be compared with those of two
control groups, consisting of women who underwent either one or two Cesarean sections
without the intervention.
The aim of the present study is to asses if the number of uterine scars and median
myometrial thickness can be improved by the resection of the first uterine scar during a
subsequent Cesarean section.
This will allow the investigators to draw conclusions regarding the benefit of routine
resections of uterine Cesarean section scars, and whether this practice could lead to a
decreased risk for women undergoing two or more Cesarean sections.
;
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Single Blind (Outcomes Assessor), Primary Purpose: Prevention
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