title: Impact of methods for uterine incision closure on repeat caesarean section scar of lower uterine segment.
abstract: OBJECTIVE
  To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness, blood loss, operative time and scar dehiscence at the time of next caesarean section.
  
  
  METHODS
  A randomized double blinded trial.
  
  
  METHODS
  Obstetrics and Gynaecology Department of Bahawal Victoria Hospital, Bahawalpur, from June 2005 to June 2010.
  
  
  METHODS
  Ninety patients undergoing repeat caesarean section were included and randomly assigned to one of the three groups. Group A underwent one layer closure; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision. Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence. Frequency percentages were obtained and compared using chi-square test with significance at p < 0.05.
  
  
  RESULTS
  In only 2 (6.6%) of modified two layer closure cases, it was necessary to use additional haemostatic sutures, compared with 16 (53%) of one layer closure group, and 10 (33%) of the two layer closure group. At 6 weeks, the mean car thickness in group C (17.08 +1.635 mm) was significantly greater (p < 0.001) as compared to group A (13.19 + 1.32 mm) and group B (14.58 +1.18 mm). At long-term follow-up, only 1 (6%) case from group C showed the "uterine window" at the time of repeat caesarean section as compared to 3 (23%) in group A and 2 (14%) in group B.
  
  
  CONCLUSIONS
  Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section.
authors.affiliation: Department of Obstetrics and Gynaecology, Unit II, Bahawal Victoria Hospital, Bahawalpur. dr.shakilayasmin@live.com
authors.forename: Shakila
authors.initials: S
authors.lastname: Yasmin
authors.forename: Joveria
authors.initials: J
authors.lastname: Sadaf
authors.forename: Naheed
authors.initials: N
authors.lastname: Fatima
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016063:Blood Loss, Surgical / Q000517:prevention & control; D017604:Cesarean Section, Repeat / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D002921:Cicatrix / Q000209:etiology*; D004311:Double-Blind Method; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006801:Humans; D011247:Pregnancy; D012307:Risk Factors; D013529:Surgical Wound Dehiscence / Q000209:etiology*; D013997:Time Factors; D014463:Ultrasonography / Q000295:instrumentation; D014597:Uterine Rupture / Q000209:etiology / Q000517:prevention & control; D014599:Uterus / Q000000981:diagnostic imaging / Q000601:surgery*; D016387:Women's Health / Q000706:statistics & numerical data*; D055815:Young Adult