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Introduction Cesarean deliveries are commonly performed throughout the world. Although the uterine closure technique following this procedure may influence how the uterine scar heals, there is insufficient evidence for choosing the appropriate technique and so preventing long‐term negative consequences. This prospective, randomized study examined the effects of single‐ and double‐layer uterine closure techniques on uterine scar healing following cesarean delivery. Material and methods This study assessed a total of 282 women aged 18‐45 years who were in gestational weeks 24‐41 of singleton pregnancies. None had previously undergone uterine surgeries. These participants completed their first cesarean deliveries at the time of study and were randomized into the following two treatment groups: single‐layer closure with locking and double‐layer closure with locking in the first layer, but not in the second layer (NCT03629028). However, the decidua was not included for treatment in either group. Participants were evaluated at 6‐9 months after cesarean section by saline infusion sonohysterography to assess cesarean delivery scar defects. These procedures were conducted by experienced sonographers who were not aware of the uterine closure technique. Results Of the 225 final participants, 109 received the single‐layer closure technique, whereas 116 received the double‐layer technique. The niche rates were 37% (n = 40) for the single‐layer group and 45.7% (n = 53) for the double‐layer group (P = .22, relative risk 1.4, 95% CI = 0.8‐4.4). Conclusions The single‐ and double‐layer closure techniques did not produce different impacts on uterine scar niche development.

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