The combined study of two-dimensional (2D) and
three-dimensional (3D) sonographic records may be useful to
diagnose wound dehiscence from hysterotomy and forecast the
well-being of future gestations. In that respect, irregular cicatrization
patterns can be identified from the early puerperium over
the whole postparturition recovery period, and may encourage
the need for further cesarean in new pregnancies to come.
Subjects and Methods: A random sample of 42 female patients
were subjected to transvaginal sonographic exploration at three
sampling times, namely 4 days, 4 months, and 1 year following
hysterotomy. All of these women recovered successfully from their
cesarean and were discharged from hospital 5 days after parturition.
The 2D and 3D surveys were subsequently undertaken at
each of the three study times. Four days after surgery, the 2D
ultrasound scan aimed at evaluating the early evolution of the
uterine scar. On the contrary, 3D echographies were implemented
frame-to-frame, in a transverse direction, from the right
to left sides of the uterus.
Results: The 3D sonographic records from those dehiscent
wounds displayed at this time a wide, irregular hypoechogenic
area crossed over by linear structures representing the suture
material (Vycril). Such a record was called a “shark bite” pattern.
The latter puerperal dehiscence pattern persisted in the
isthmic region for 4 months and 1 year after delivery. It consistently
featured a notch between the scar borders that run
perpendicular to the complete extent of the internal myometrium
layer and bordered the anterior uterine wall.
By considering the length of the hysterotomy-derived notch
over the whole study period, two types of scars could be differentiated
through 2D sonographic surveys, scar notches >2/3
(n=9) or =1/3 (n=4) of the total scar lengt. Six of the 13 wounddehiscent
women monitored in this study became pregnant
within 2 years after their former cesarean.
All were subjected to a second hysterotomy, before which an
in situ examination of the previous uterine scar could be made.
Early puerperal ultrasound scan focusing on hypoechogenic
areas across the borders of hysterotomy-derived scars under
suturing pressure must be undertaken by means of 2D transvaginal
ultrasound scan, with the bonus that such exploration
can be extended through several months to a 1 year period
after surgery. The extent of dehiscent myometrium areas and
the depth of the notch remaining between the serose and the
cervical channel of the stigma can be used as reliable indicators
for defective cicatrization processes and should be used as
background information aiding in future gestations.
The 3D transvaginal ultrasound scan provides the practitioner
with thorough records of myometrial failure and enhances the
morphological study of iatrogenic pathologies originating from
The state and extent of healed vs failing cicatrization areas can
be easily assessed by means of 3D transvaginal ultrasound scan.
Keywords: Cesarean section, Cicatrix, Pregnancy, Three
dimensional ultrasound, Wound healing.
How to cite this article: Troyano JM, Clavijo MT, Martinez-
Wallin I, Molina-Betancor A, Alvarez-de-la-Rosa M, Padilla
AI, Bajo-Arenas J. Cesarean Scar Hysterotomy: Assessment
by Three-dimensional Transvaginal Ultrasound Scan. Donald
School J Ultrasound Obstet Gynecol 2017;11(1):82-87.
Source of support: Nil
Conflict of interest: None