Effects of visceral peritoneal closure on scar formation at cesarean delivery

Objective: To determine the effect of closure or non-closure of the visceral peritoneum at cesarean delivery on uterine scar formation assessed at repeat cesarean delivery. Methods: Women undergoing initial cesarean delivery were allocated into 2 groups: group I underwent visceral peritoneal closure, while in group 2 the visceral peritoneum was not closed. At repeat cesarean delivery 4 specimens from the initial uterine scar were collected and assessed by light microscopy and scanning electron microscopy. Results: In group 1, 57% of women had adhesions compared with 20.6% in group 2 (P<0.05). Light microscopy revealed reactive mesothelial hyperplasia (51.8% vs 13.7%), submesothelial fibrosis (48.1% vs 6.8%), and neoangiogenesis of mesothelial stroma (44.4% vs 12%) in group 1 and group 2 patients, respectively (P<0.05). Scanning electron microscopy showed more patients with pericytes on the surface of microvessels in group 1 compared with group 2 (26.3 +/- 1.4 vs 11.5 +/- 1.1 patients; P<0.05). Conclusion: Closure of the visceral peritoneum at cesarean delivery may produce an inflammatory reaction and adhesions, evidenced by reactive and regenerative mesothelial hyperplasia and submesothelial fibrosis. (C) 2009 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.