Single Versus Double Layer Uterine Closure Technique According to Development of Uterine Niche: A Literature Review

Abstract

Prevalence of cesarean deliveries increases globally. The prevalence of cesarean births increased from 5% in 1970 to 31.9% in 2016. There are short term and long-term complications of cesarean delivery including uterine niche. After a cesarean, the uterus is closed using a variety of methods, such as single- and double-layer closures with/without locking. This study compared single-layer and double-layer uterine closure with regard to the outcomes and complications. This review was synthesized and obtained from various online databases. Scientific articles were selected based on the inclusion criteria. The result showed that cesarean deliveries is a hysterotomy and an open abdominal incision (laparotomy) to deliver the fetus. An iatrogenic pouch-like defect known as a uterine niche result from improper tissue repair at the site of a prior cesarean scar. Up to 70% of women who have had a prior cesarean section experience uterine niche, of which 30% have symptoms. Compared to a single full-thickness closure, a single-layer, decidua sparing closure approach is more likely to result in an incomplete closure. No differences were discovered between the single- and double-layer closure techniques with locked first layers, but double-layer closures without locking resulted in thicker residual myometrium thickness when compared with locked single-layer closures. It is also possible that the locked suture can strangulate the scar tissue leading to poorer healing. Current evidence shows that no significant difference between single-layer and double-layer uterine closure techniques following in terms of uterine niche development.