Preventing Isthmocele After Cesarean Section (PICS): A Pilot Randomized Controlled Trial

Abstract

Cesarean delivery accounts for approximately 30% of deliveries in Canada. A cesarean scar defect (CSD), or isthmocele, is a myometrial defect ≥2 mm in depth at the cesarean scar site that can lead to major obstetrical and gynaecological complications.1 Although CSD treatments exist, interest has shifted to prevention, with suture technique being the most modifiable risk factor. Some studies have suggested a double-layer closure decreases CSD formation and increases residual myometrial thickness,2 but systematic reviews have suggested no difference between a single versus double-layer closure.