Sparse Uterine Closure in Cesarean Section
Condition: Caesarean Scar Defect
Study type: Interventional

Summary: 
      The existence and the characteristics of a wedge- shaped defect in the uterine incision scar
      were demonstrated by radiologic, ultrasonographic, endoscopic and histologic methods by
      various authors.

      Cesarean scar defect is a deficient uterine scar or scar dehiscence following a cesarean
      section involving myometrial discontinuity at the site of a previous cesarean section scar.
      Cesarean scar defects may be associated with many clinical problems such as ectopicpregnancy
      at the cesarean section scar, rupture of the uterus during a subsequent pregnancy,
      dysmenorrhea and abnormal uterine bleeding during the non-pregnant state. These complications
      are likely to be associated with poor uterine scar healing following cesarean sections.

      Methods concerning closure of the uterine incision need to be considered with regards to
      benefit and potential harm in order to offer the best available surgical care to women
      undergoing cesarean section.

      Sur-gical suturing technique and mechanical tension affecting the surgical wound are the most
      important factors related to the incisional integrity.

      For this reason, investigators designed this prospective clinical study to analyze the
      effects of two different uterine suturing techniques. their aim was to compare the sparse
      closure of the uterine incision to classical one layer closure regarding short , mid and long
      term results. In deed, they compared :

        -  duration of surgery and calculated blood loss during surgery as short term results -
           incidence of postoperative defective healing of the uterine incision , thickness of the
           ultrasound imaged uterine scar as mid-term results .

        -  Incomplete uterine rupture, morbidly placental adhesion during subsequent pregnancy of
           these patients as long-term results.
    

Detailed description: 
      This is a secondary analyse of a first randomised trial comparing two caesarean techniques :

        -  Misgav Ladach with a one layer classic uterine closure.

        -  French ambulatory Caesarean section with a sparse uterine closure . The first trial is
           registred under the reference number : NCT03741907. 100 patients with an indication of
           an elective caesarean section were included in this trial : 50 had a one layer classic
           uterine closure and are enrolled in groupe 1 and 50 had a sparse uterine closure and are
           enrolled in groupe 2 .

        -  For the short term results investigators compared : duration of uterine sutures ,
           visually estimated and calculated blood loss

        -  For the mid term results investigators are shuduling for all partient an
           hysterosonography 6 mounths after surgery and then will compare : incidence of
           postoperative defective healing of the uterine incision , thickness of the ultrasound
           imaged uterine scar as mid-term results .

        -  For the long term results investigators will interview patients 2 years after surgery in
           order to check for Incomplete uterine rupture, morbidly placental adhesion during
           subsequent pregnancy .
    

Intervention name(s): sparse uterine suture; one layer uterine closure
Intervention type(s): Procedure; Procedure
Intervention description(s): The slowly absorbed Vicryl 1 suture with a large round needle is introduced intramyometrially right above the endometrium. The suture starts in one corner and proceeds along the lower then the upper edge returning back to the incision point. Subserous layer is closed upon using the same thread in order to cover the purse suture and to complete the haemostasis while increasing the wound thickness.; one layer classical continious uterine closure using slowly absorbed Vicryl 1
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Prevention
Keywords: caesarean; scar defect; sparse uterine suture; one layer uterine suture; blood loss; ultrasound