Single‐ or double‐layer uterine closure techniques following cesarean: A randomized trial

Abstract

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.

Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis

“…Although the DL closure showed better sonographic outcomes, as revealed by the present study and previous studies [ 9 ], these outcomes seem to be clinically insignificant [ 8 , 28 ]. Thus, SL closure is still the most popular method for uterine closure after CS delivery.…”

“…However, a recent trial reported similar rates with both techniques [ 8 ]. In our study, the superiority of the DL closure method was attributed to the recent trial by Yilmaz Baran 2020 [ 28 ], while the other pooled trials showed insignificant results [ 3 , 15 , 22 ]. Thus, the present study solves this debate in favor of the DL closure technique by pooling the results of all previously published RCTs.…”

“…As the results of our study found, SL closure is known to be easier and faster than DL closure [ 9 , 28 ]. Most obstetricians prefer SL to DL closure in order to decrease operative time with no significant increase in the risk of complications [ 3 , 13 ].…”

“…Of these articles, 2907 were excluded, and 111 full-texts were retrieved and screened according to our eligibility criteria. Finally, 18 studies were considered eligible for inclusion in the meta-analysis [ 3 , 8 , 13 - 28 ]. Figure 1 summarizes the flow of the study selection process and data collection.…”

Adjunctive azithromycin prophylaxis protects women from uterine cesarean scar defect: A randomized controlled trial

“…The etiology of CSD has yet to be fully elucidated because conclusive data are lacking. Notably, it is unclear whether a double‐layer suture of the uterine incision is better than a single‐layer suture 12,13 . In particular, there is a lack of research on patient‐related factors such as infection and genetic differences, which may be underestimated 14 .…”