A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness

Abstract

A double layer closure of the hysterotomy is associated with a thicker myometrium scar only in primary or elective Cesarean delivery patients.

Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta‐analysis

“…Our results are in line with the results of these reviews concerning short-term outcomes 13,14 or RMT 13,15 when single-and double-layer uterine closure were compared. We were able to include five additional studies [21][22][23]31,34 for single-versus double-layer closure reporting on scar healing, and five studies 22,23,26,30,39 for locked versus unlocked suturing. We were able to include five additional studies [21][22][23]31,34 for single-versus double-layer closure reporting on scar healing, and five studies 22,23,26,30,39 for locked versus unlocked suturing.…”

“…We determined potential publication bias statistically for our primary outcome using Egger's and Begg's test. Three studies [22][23][24] were considered of high risk of bias for the item 'incomplete outcome data', due to incomplete follow-up data and imbalance in missing data across intervention arms. We also stratified the results for risk of bias.…”

“…One study (n = 50) 21 evaluated our primary outcome without any of our secondary outcomes, resulting in 15 003 included women for secondary outcome evaluation. Three RCTs compared both single-versus double-layer and locked versus unlocked closure 22,23,30 and one prospective cohort study compared both single-versus double-layer closure and inclusion versus exclusion of the decidual layer. The overall methodological quality of included RCTs was moderate to high (Figure S2).…”

“…The overall methodological quality of included RCTs was moderate to high (Figure S2). Three studies [22][23][24] were considered of high risk of bias for the item 'incomplete outcome data', due to incomplete follow-up data and imbalance in missing data across intervention arms. One study 25 did not report on blinding of the ultrasound examiner or on all prespecified outcomes (ultrasound at 6 weeks follow up) so it was scored as high risk of bias for both 'blinding of outcome assessment' and 'selective reporting'.…”

“…It has been demonstrated recently that the number of previous CS, 41 the use of transvaginal ultrasound and application of gel or saline, 12 and the time between the CS and ultrasound evaluation 23,31,33,42 influence ultrasonographic measurements of the niche. Only a limited number of studies reported on long-term outcomes.…”