Effect of Single versus Double Layer Suturing on Healing of Uterine Scar after Cesarean Delivery

Abstract

Background: Cesarean delivery is the one of the oldest procedures performed in the history of surgery. Nowadays closure of the uterine incision is a key step in CD, particularly given the increasing awareness of future scar dehiscence. Aim: to improve quality of cesarean delivery. Objective: to assess healing after single- and double-layer suturing of uterine scar. Patients and Method: Randomized clinical trial conducted at Obstetrics and Gynecology department, Suez Canal University Hospital. Eighty primigravida women with full term pregnancy undergoing first elective CS were equally randomized to either single-layer or double-layer unlocked suture. Six weeks after the operation, the integrity of the cesarean scar done by 2 operators was assessed by sonohysterography. The thickness of the residual myometrium covering the defect RMT, width of the triangular hypoechoic niche W”, depth of the triangular hypoechoic niche D and healing ratio D/RMT were calculated as markers of uterine scar healing. Results: There were no significant differences between the groups in terms of estimated blood loss, operation time, or additional hemostatic suture. However, frequency of appearance of niche in single layer patients was 65% compared to 30% in the double layer patients. The mean thickness of the residual myometrium covering the defect was significantly higher 9 ± 1.1 mm after double-layer than 7.9 ± 0.92 mm after a single-layer closure (P = 0.002). The mean healing ratio in double-layer was 0.2948 ± 0.05 versus 0.2969 ± 0.04; P =0.922 in the single-layer closure. Conclusions: Double unlocked layer closure was associated with higher residual myometrial thickness than locked single layer and better uterine scar healing