Uterine Closure in Cesarean Delivery: A New Technique

Abstract

Fear of scar rupture is one of risks involved in a post caesarean pregnancy. This had led to an increased rate of repeat cesarean delivery in today's times. Closure of the uterine incision is a key step in cesarean section, and it is imperative that an optimal surgical technique be employed for closing a uterine scar. This technique should be able to withstand the stress of subsequent labor. In the existing techniques of uterine closure, single or double layer, correct approximation of the cut margins, that is, decidua-to-decidua, myometrium to myometrium, serosa to serosa is not guaranteed. Also, there are high chances of inter surgeon variability. It was felt that if a suturing technique which ensures correct approximation of all the layers mentioned above with nil or minimal possibility of inter operator variability existed, there will not be any thinning of lower segment caesarean section (LSCS). Further, a scarred uterus repaired in this manner will be able to withstand the stress of labor in future. We hereby report a new technique for uterine closure devised by us, which incorporates a continuous modified mattress suture technique as a modification of the existing surgical technique of uterine closure.

Niche development after closure of caesarean uterotomy by conventional double‐suture or modified single‐suture technique (NICUM): A randomized trial

“…Magon and Babu et al 21 described their method as a single‐layer technique; however, although one suture (string) is applied, it could be argued that the closure method acts as a pseudo double‐layer closure with myometrium to myometrium and serosa to serosa, respectively.…”

“…[18][19][20] The interpretation of the evidence may be challenged by difficulties in the standardization of perioperative factors such as surgeon's expertise or inter-operator variation and by varying timing, method for evaluating the niche, and definition of outcomes. 6,19,20 Magon and Babu et al 21 proposed a new technique for uterotomy suturing; a continuous technique with alternating stitches between deep myometrial and superficial serosa layer involvement using single running sutures. Compared to a double-suture method with a somewhat forced approximation of the second layer, this modified method intuitively seems to improve the alignment of the myometrial and serosal layers.…”

“…Magon and Babu et al 21 proposed a new technique for uterotomy suturing; a continuous technique with alternating stitches between deep myometrial and superficial serosa layer involvement using single running sutures. Compared to a double‐suture method with a somewhat forced approximation of the second layer, this modified method intuitively seems to improve the alignment of the myometrial and serosal layers.…”

Letter to “Babu and Magon uterine closure technique during cesarean section: A randomized double‐blind trial”

“…It could possibly due to an incorrectly drawn figure or an incorrectly performed technique. 2 If it is the latter case, it is to be emphasized that an incorrect surgical technique has a great adverse impact on the final outcome of the scar.…”