Uterine Closure Techniques and Cesarean Scar Defect Risk
Condition: Cesarean Section Complications; Scar; Deformity
MeSH terms: Congenital Abnormalities
Study type: Interventional

Summary: 
      Cesarean operations are one of the most common obsetric operations and have an increasing
      trend in all over the world. However unfortunately the operation techniques have not been
      standardized yet. It is well known that different uterine closure techniques result in
      differences with respect to wound healing on the uterus; however, the ideal uterine closure
      technique is yet not known. The aim of this study is to assess the results of different
      uterine closure techniques during cesarean section with respect to the development of
      cesarean scar defects.
    

Detailed description: 
      Patients were randomized into three groups using a computer-based program (ratio 1:1:1), and
      the assigned surgical technique was disclosed just before surgery. At the time of surgery,
      the sealed opaque envelope, numbered consecutively and containing the description of the
      suturation technique, was given to the operator. Suturing techniques varied between groups:
      double layer continuous, non-locking suturing with endometrial inclusion, second layer
      imbricating the first layer (Group 1), double layer, continuous, non-locking suturing without
      endometrial inclusion second layer imbricating the first layer (Group 2) and double layer
      continuous with the first layer unlocked, including the endometrium and the deep part of the
      myometrium, and the second layer continuous unlocked including the remaining part of the
      myometrium (Group 3) (Figure 2). Size 1 polyglycolic acid 910 (Vicryl ® Ethicon Inc.
      Somerville, NJ) was used as suture material in all groups.

      Patients were re-evaluated at the sixth month as uterine scar healing is reported to be
      completed within six months and preoperative assessments were repeated. Transvaginal
      ultrasonography was performed by an investigator blinded to suturing techniques. Measurements
      included RMT, and CSD assessment (as the primary outcomes) (including the depth and width of
      the CSD), as well as other routine ultrasonographic evaluations. Transvaginal sonography was
      performed by the same investigator with a Toshiba Applio 500 device using a PMW-621VT 6 Mhz
      R13 probe. CSD was considered when myometrial continuity in the previous caesarean incision
      site was lost, and an anechoic defective area towards the myometrium was noted. In patients
      who did not develop CSD, the incision line was measured anteriorly, and the symmetrical
      posterior uterine wall thickness was measured. In patients with CSD, the myometrium tissue
      above the anechoic defective area was evaluated as residual myometrial thickness. The CSD
      sac's depth and its base's width were measured. The full-thickness myometrium adjacent to the
      defect area was measured, and recovery rates were calculated by taking the percentage of the
      residual myometrial thickness over the defect to the full-thickness myometrium.
    

Intervention name(s): Uterine closure during Cesarean section
Intervention type(s): Procedure
Intervention description(s): The uterotomy is sutured after the delivery of the fetus and the placenta with an appropriate delayed absorbable suture (number 1 polyglactin 910)
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: cesarean scar defect; cesarean section; uterine closure techniques