Robson’s class and caesarean scar defects

Caesarean scar defect (CSD) may lead to the occurrence of gynecologic symptoms such as abnormal uterine bleeding secondary to intermittent passage of retained menstrual blood within the CSD pelvic pain, and infertility. This prospective cohort study was conducted at the Department of Obstetrics at Maria Vittoria Hospital in Turin (Italy), from January 2013 to December 2013 to analyze the effects of two different suturing techniques (single layer and double layer closure of the hysterotomy) and Robson's class impact on the incidence of CSD. All procedures were performed using a modified Stark technique by the same single senior surgeon. The way of closure of the uterine incision was alternated every three months, in order to have two groups of partecipants: one with a single layer and the other with a double layer closure technique. Single layer was carried out as one continuous locking stitch; double layer was performed with a first closure identical to the single layer and an additional suture with a continuous unlocked stitch used to imbricate the first layer. Both ways of closure of the uterine incision were performed using monofilament synthetic absorbable polydioxanone suture. Twelve months after their caesarean section, the women had an ultrasound examination of the uterine scar performed by a single experienced operator blinded to suture technique and the Robson class. The trial recruited 85 cases. 21 patients (24.8%) belonged to Robson's class 1, 5(6%) to class 2, 1(1.3%) to class 4, 35(41%) to class 5, 13(15.4%) to class 6, 6(7%) to class 7, 4(4.5%) to class 8. During the ultrasound follow up we found 10 CSD (11,8%): 8/10 CSD (80%) were found in Robson's class 5, 1 in class 1 and 1 in class 6 (p 0.008), with no correlation with single- or double-layer suture (p 0.141). To our knowledge, no previous studies evaluated the correlation with Robson classification and CSD.