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Uterine Scar Healing After Cesarean Section: Managing an Old Surgery in an Evidence-Based Environment

Cesarean section is one of the most commonly undertaken operations worldwide, and its rate is constantly increasing in recent years both in middleand highincome countries, despite several scientific societies developing informative campaigns to support vaginal delivery whenever it is possible in order to avoid complications in future pregnancies. Among the most important pieces of evidence about this point, more than 10 years ago the World Health Organization performed a global survey on maternal and perinatal health in Latin America, one of the areas with the highest rate of cesarean section worldwide;1 this multistage stratified sample comprised 24 geographic regions in eight countries, collecting data from 97,095 deliveries. According to this large cohort analysis, rate of cesarean delivery was positively associated with severe maternal morbidity and mortality, even after adjustment for risk factors; in addition, it was positively associated with a significant increase in fetal mortality rates and higher numbers of babies admitted to intensive care for 7 days or longer, even after adjustment for preterm delivery. Although cesarean section may be considered as a standardized technique, several different approaches may underlie different outcomes; in 2014, the Cochrane Collaboration published the updates of two interesting systematic reviews and meta-analyses,2,3 trying to shed new lights about the topic. The first report investigated the effects of nonclosure as an alternative to closure of the peritoneum on intraoperative and immediateand long-term postoperative outcomes,