Evaluation of single-layer versus double-layer suturing of low transverse uterine incisions in cesarean section and follow-up of scars by ultrasound: a prospective randomized controlled study

Abstract

Background/aim: Cesarean section(CS) is a widely performed operation worldwide. Data about uterine closure is lacking. We aimed to evaluate scar niches and compare the single and double-layer uterine closure after six months following CS.Materials-Methods: A prospective, randomized trial assessed 56 women undergoing single or double-layer uterine closure. None of the patients had previous uterine surgery. The CSs were elective cases. Transvaginal ultrasound was performed six months after CS to assess uterine scar by measuring the width, depth, and length of scar niche and residual myometrial thickness. An experienced sonographer was blinded to the uterine closure technique and the ultrasounds were conducted as unaware of the technique in the postoperative follow-ups. Results: Twenty-eight cases were allocated to each single-layer closure (Group 1) and double-layer closure arm (Group 2). Demographic and clinical characteristics of patients, the width, depth, diameter of the niche, and residual myometrial thickness were similar among groups. There was no difference in uterine scar volume under incision between the two groups. The duration of surgery was about five minutes longer (p=0.048), and hemoglobin loss was about 0.5 g/dl less (p=0.039) in the double-layer group compared to the single-layer. Postmenstrual spotting rates were also similar among groups. Group 1 had two, and Group 2 had one spontaneous pregnancy within six months after CS.Conclusion: The single and double-layer closure techniques do not produce any different impacts on cesarean scar niche features after six months of delivery. In addition, ultrasound might be an important non-invasive diagnostic tool to understand CS scar remodeling.