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Am J Perinatol 2011; 28(7): 543-550
DOI: 10.1055/s-0031-1272973
© Thieme Medical Publishers

Augmenting Myometrial Healing after Cesarean Delivery: Use of an Adjuvant Biologic Graft Placement in an Ovine Model

John M. O'Brien1 , Daniel Whetham2 , Christopher Fecteau3 , John Jansen4 , Michael Hiles3
  • 1University of Kentucky, Lexington, Kentucky
  • 2Cook Medical Corporation, Bloomington, Indiana
  • 3Cook Biotech Incorporated, West Lafayette, Indiana
  • 4Central Baptist Hospital, Lexington, Kentucky
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Publication History

Publication Date:
01 March 2011 (online)

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ABSTRACT

We sought to reduce long-term complications after cesarean delivery by improving myometrial healing. Eight sheep (three with twins) underwent cesarean delivery. Hysterotomy sites were repaired in equal parts by suture alone or suture with a juxtaposed graft (Cook Medical, Bloomington, IN). At 90 days postsurgery, scar characteristics and tensile strength testing were assessed. The mean hysterotomy closure time was on average 1 minute, 14 seconds longer for those undergoing graft placement (p = 0.36). The mean scar thickness was 3.0 ± 0.4 mm for controls versus 3.8 ± 1.2 mm for the intervention group (p = 0.047). Tensile strength testing did not demonstrate a significant difference between groups. Histological examination of the myometrial scar showed no significant differences in inflammatory reaction or endometrial inclusions; however, neoangiogenesis was significantly enhanced. Myometrial repair incorporating a graft increased scar thickness and neoangiogenesis. This methodology did not incite adenomyosis or enhance inflammation within the scar.

KEYWORDS

Cesarean delivery - graft - hysterotomy - ovine model - small intestinal submucosa

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John M O'BrienM.D. 

Director, Maternal Fetal Medicine

University of Kentucky, 800 Rose Street, Lexington, KY 40536

Email: john.obrien2@uky.edu