Evaluation of incision healing status after transverse uterine fundal incision for cesarean delivery and postoperative pregnancy: a ten-year single-center retrospective study

Table 1 Details of twenty-three patients who conceived and delivered after transverse uterine fundal incision

Case No.	Data of TUFI^*1 wound					Delivered twice post-TUFI^*1	Surgical outcome
	Incision position^*2	MRI findings (12 months after TUFI^*1)		Findings in Cesarean Section at the subsequent pregnancy			Previous Cesarean Section (TUFI^*1)		Subsequent Cesarean Section
	Incision position^*2	Wound thickness index^*3	Vasculari-zation^*4	Visual observation^*5	Bimanual examination^*6		Placenta-accreta (clinically)	Total fluid loss^*7	Gestational age (weeks)	Total fluid loss^{7 8}
1	posterior	100%	grade 0	A	25%	+		1643 g	34	2130 g
2	anterior	97%	grade 1	B	50%	+		1178 g	37	1633 g
3	posterior	96%	grade 2	A	75%			891 g	36	1275 g
4	posterior	96%	grade 2	A	75%			2209 g	34	3037 g
5	anterior	94%	grade 0	A	50%		+	2400 g	36	977 g
6	posterior	93%	grade 2	A	50%			1369 g	34	1708 g
7	anterior	92%	grade 2	A	75%			388 g	35	1011
8	posterior	91%	grade 1	C	50%			1820 g	36	1935
9	posterior	87%	grade 1	B	50%			1016 g	36	1209
10	posterior	86%	grade 2	A	50%			866 g	36	711 g
11	posterior	83%	grade 2	A	25%			521 g	36	705 g
12	posterior	83%	grade 1	B	50%			507 g	36	1065 g
13	posterior	81%	grade 1	A	50%			1130 g	36	1276 g
14	posterior	81%	grade 1	A	50%			575 g	33	732 g
15	anterior	79%	grade 1	A	25%			689 g	34	2207 g
16	anterior	77%	grade 2	C	75%			1830 g	37	1836 g
17	posterior	77%	grade 1	A	75%			495 g	36	1815 g
18	posterior	77%	grade 1	B	50%			680 g	36	2285 g
19	posterior	73%	grade 1	B	50%			864 g	36	1734 g
20	posterior	71%	grade 1	C	50%	+		724 g	36	909 g
21	anterior	70%	grade 2	A	50%			1099 g	36	933 g
22	posterior	69%	grade 1	C	25%			1377 g	34	1055 g
23	anterior	53%	grade 1	C	25%			874 g	36	1412 g

*1. TUFI: transverse uterine fundal incision for Cesarean delivery
*2. The incision was made several cm away either anterior or posterior to the line connecting the Fallopian tube angles on both sides
*3. The thickness of the scar area was compared with the thickness of the surrounding muscle layer by MRI (see Fig. 3)
*4. The visual assessment of the enhanced scar area using contrast-enhanced MRI was performed as follows: grade 0: not enhanced, grade 1: parts of the scar were enhanced, grade 2: >80% of the scar was enhanced (see Fig. 4)
*5. The scar area was visually examined during the Cesarean section in the subsequent pregnancy. A: the indentation was difficult to find, B: a minor indentation was observed, C: the indentation was clearly observed (see Fig. 7)
*6. The TUFI wound thickness was compared to the thickness of the surrounding normal tissue after placental delivery by bimanual examination during the Cesarean section in the subsequent pregnancy
*7. Total fluid loss included both blood and amniotic volumes
*8. Among four patients with total fluid loss of over 2000 g, two patients lost a large amount of amniotic fluid (cases 1 and 15), one patient had a myomectomy during surgery (case 18), and one patient had a hematologic medical history (case 4)

ISSN: 1471-2393