The impact of mechanical cervical dilatation during elective cesarean section on postpartum scar integrity: a randomized double-blind clinical trial

Ayman Shehata Dawood,1 Adel Elgergawy,1 Ahmed Elhalwagy,1 Walid M Ataallah,1 Shereen B Elbohoty,1 Shereef L Elshwaikh,1 Amal A Elsokary,1 Ahmed M Elkhyat,1 Amr T Elbadry,2 Ahmed M Abbas3 1Department of Obstetrics & Gynecology, Faculty of Medicine, Tanta University, Tanta, Egypt; 2Department of Radiology, Faculty of Medicine, Tanta University, Tanta, Egypt; 3Department of Obstetrics & Gynecology, Faculty of Medicine, Assiut University, Assiut, Egypt Objective: The current study aimed to evaluate the impact of mechanical cervical dilatation during elective cesarean section (CS) on postpartum scar integrity at 6 months post operation. Methods: A randomized double-blind clinical trial (UMIN000027946) was conducted at a tertiary university hospital in the period between July 1, 2017 and April 30, 2018. The study included pregnant women with a singleton fetus at term ≥37 weeks of gestation scheduled for elective CS. Eligible participants were allocated either to the study group (women with intraoperative cervical dilatation) or the control group (women with no intraoperative cervical dilatation). The patients were followed up at 6 months after CS by 3D ultrasonography to check for the scar integrity and quality. The primary outcome was the difference in sonographic parameters of the scar integrity between the two groups. Results: Four hundred twenty two women were approached to participate in the study. There was no statistically significant difference regarding the baseline characteristics of both the groups. Scar width and depth were significantly higher in the cervical dilatation group (P=0.002 and 0.001, respectively). Fewer cases with scar defects (niche) were found in the cervical dilatation group than in the control group (5.03% vs 11.04%, respectively, P=0.048). There was no significant difference regarding the rate of wound infection or endometritis in both the groups (P=0.717 and 0.227, respectively). The incidence of febrile morbidity was higher in the no cervical dilatation group (10.5%) compared to (5.0%) the cervical dilatation group (P=0.045). Conclusion: Cervical dilatation during elective CS is associated with thick scars with low incidence of scar defects. Keywords: cesarean section, cervical dilatation, cesarean scar defect, scar integrit