{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T22:49:13Z","timestamp":1779230953972,"version":"3.51.4"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T00:00:00Z","timestamp":1629158400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T00:00:00Z","timestamp":1629158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Henry Shears Professorship"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pregnancy Childbirth"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>To investigate whether the existing surgical technique for uterine closure at repeat lower segment Caesarean section (LSCS) can be modified to achieve adequate residual myometrial thickness (RMT) to ensure scar integrity and reduce complications in future pregnancy.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Women with a significant scar defect at repeat LSCS had the anterior uterine wall closed by a single experienced obstetrician with a technique focused on recognition, mobilisation and apposition of the retracted myometrial edges at the boundary of the defect. This was aimed at anatomical restoration of the lower segment. The RMT at the scar area was assessed by postnatal pelvic ultrasound scan at three months.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Thirty women with a history of at least one previous CS, incidentally found to have a large defect at operation underwent the technique with prior consent. A postnatal scan showed a mean residual myometrial thickness of 8.4\u2009mm (SD \u00b11.3\u2009mm; range 5.6\u201311.0\u2009mm). The average operating time was 91 mins and the average blood loss 728\u2009ml. Two women who underwent the repair have gone on to have a further uneventful CS.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>This modified technique resulted in scan evidence of an RMT indicative of uterine wall stability postnatally and offers the potential for reducing the risk of rupture and placenta accreta spectrum (PAS) in future pregnancy.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12884-021-04040-9","type":"journal-article","created":{"date-parts":[[2021,8,17]],"date-time":"2021-08-17T08:04:02Z","timestamp":1629187442000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Repair of the myometrial scar defect at repeat caesarean section: a modified surgical technique"],"prefix":"10.1186","volume":"21","author":[{"given":"Shahul Hameed Mohamed","family":"Siraj","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4510-0462","authenticated-orcid":false,"given":"Karuna Mary","family":"Lional","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kok Hian","family":"Tan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann","family":"Wright","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,8,17]]},"reference":[{"issue":"2","key":"4040_CR1","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1002\/uog.12479","volume":"42","author":"N Kok","year":"2013","unstructured":"Kok N, Wiersma IC, Opmeer BC, de Graaf IM, Mol BW, Pajkrt E. Sonographic measurement of lower uterine segment thickness to predict uterine rupture during a trial of labor in women with previous cesarean section: a meta-analysis. Ultrasound Obstet Gynecol. 2013;42(2):132\u20139. https:\/\/doi.org\/10.1002\/uog.12479.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"5","key":"4040_CR2","doi-asserted-by":"publisher","first-page":"1104","DOI":"10.1097\/AOG.0000000000003793","volume":"135","author":"BD Einerson","year":"2020","unstructured":"Einerson BD, Comstock J, Silver RM, Branch DW, Woodward PJ, Kennedy A. Placenta Accreta Spectrum disorder: uterine dehiscence. Not Placental Invasion Obstet Gynecol. 2020;135(5):1104\u201311. https:\/\/doi.org\/10.1097\/AOG.0000000000003793.","journal-title":"Not Placental Invasion Obstet Gynecol"},{"issue":"5","key":"4040_CR3","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1097\/OGX.0000000000000561","volume":"73","author":"TL Glenn","year":"2018","unstructured":"Glenn TL, Bembry J, Findley AD, Yaklic JL, Bhagavath B, Gagneux P, et al. Cesarean scar ectopic pregnancy: current management strategies. Obstet Gynecol Surv. 2018;73(5):293\u2013302. https:\/\/doi.org\/10.1097\/OGX.0000000000000561.","journal-title":"Obstet Gynecol Surv"},{"issue":"2","key":"4040_CR4","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1111\/1471-0528.12542","volume":"121","author":"LF van der Voet","year":"2014","unstructured":"van der Voet LF, Bij de Vaate AM, Veersema S, Brolmann HA, Huirne JA. Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG. 2014;121(2):236\u201344. https:\/\/doi.org\/10.1111\/1471-0528.12542.","journal-title":"BJOG."},{"issue":"1","key":"4040_CR5","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1002\/uog.8864","volume":"37","author":"AJ Bij de Vaate","year":"2011","unstructured":"Bij de Vaate AJ, Brolmann HA, van der Voet LF, van der Slikke JW, Veersema S, Huirne JA. Ultrasound evaluation of the cesarean scar: relation between a niche and postmenstrual spotting. Ultrasound Obstet Gynecol. 2011;37(1):93\u20139. https:\/\/doi.org\/10.1002\/uog.8864.","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"12","key":"4040_CR6","doi-asserted-by":"publisher","first-page":"2695","DOI":"10.1093\/humrep\/dev240","volume":"30","author":"AJ Vervoort","year":"2015","unstructured":"Vervoort AJ, Uittenbogaard LB, Hehenkamp WJ, Brolmann HA, Mol BW, Huirne JA. Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development. Hum Reprod. 2015;30(12):2695\u2013702. https:\/\/doi.org\/10.1093\/humrep\/dev240.","journal-title":"Hum Reprod"},{"issue":"9","key":"4040_CR7","doi-asserted-by":"publisher","first-page":"664","DOI":"10.5603\/GP.2016.0063","volume":"87","author":"K Futyma","year":"2016","unstructured":"Futyma K, Ga\u0142czy\u0144ski K, Romanek K, Filipczak A, Rechberger T. When and how should we treat cesarean scar defect - isthmocoele? Ginekol Pol. 2016;87(9):664\u20138. https:\/\/doi.org\/10.5603\/GP.2016.0063.","journal-title":"Ginekol Pol"},{"issue":"4","key":"4040_CR8","doi-asserted-by":"publisher","first-page":"755","DOI":"10.1007\/s00404-014-3455-6","volume":"291","author":"BL Brahmalakshmy","year":"2015","unstructured":"Brahmalakshmy BL, Kushtagi P. Variables influencing the integrity of lower uterine segment in post-cesarean pregnancy. 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