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Obstetrics & Gynecology 2007;109:691-700
© 2007 by The American College of Obstetricians and Gynecologists
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ORIGINAL RESEARCH

Biomechanical Properties of the Lower Uterine Segment Above and Below the Reflection of the Urinary Bladder Flap

Catalin S. Buhimschi, MD1, Irina A. Buhimschi, MD1, Guomao Zhao1, Edmund Funai, MD1, Gheorghe Peltecu, MD2, George R. Saade, MD3 and Carl P. Weiner, MD4

From the 1Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University, New Haven, Connecticut; 2Department of Obstetrics and Gynecology, Filantropia Clinical Hospital, Bucharest, Romania; 3Department of Obstetrics, Gynecology and Reproductive Sciences, University of Texas Medical Branch, Galveston, Texas; and 4Department of Obstetrics and Gynecology, University of Kansas School of Medicine, Kansas City, Kansas.

OBJECTIVE: To test the hypothesis that differences in the matrix arrangement of the lower uterine segment (above and below the reflection of the bladder flap) translate to differences in biomechanical or structural properties of the uterine wall.

METHODS: We enrolled prospectively 40 women at term randomized to a bladder flap (n=21) versus no bladder flap (n=19) at the time of a cesarean delivery for dystocia. Tensile properties of tissue biopsies from the upper and lower edges of the hysterotomy incision were quantitated using a stretching regimen designed to mimic labor. Parameters such as slope, yield point, and break point were analyzed in relationship to biochemical (total collagen, sulfated glycosaminoglycans, pyridinoline-deoxypyridinoline) and histological (collagen birefringence) properties of the tissue.

RESULTS: The lower edge of the hysterotomy had a higher collagen content than the upper, independently of whether the hysterotomy site was above or below the reflection of the bladder (P<.001 for edge level, P=.8 for bladder flap). The pyridinoline-to-collagen ratio (a reflection of collagen cross-linking) was significantly decreased in the lower edge of the hysterotomy, independently of a bladder flap (P<.001). Neither collagen birefringence nor the amount of sulfated glycosaminoglycans differed among sites. There were no significant differences in biomechanical properties between the upper and lower edges of the hysterotomy, whether or not a bladder flap was created.

CONCLUSION: The lower uterine segment of women with dystocia maintains its overall biomechanical properties despite significant quantitative and qualitative differences in fibrillar collagen between the upper and lower edge of the hysterotomy incision.

LEVEL OF EVIDENCE: II






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