Comparison of the primary cesarean hysterotomy scars after single- and double-layer interrupted closure.
BACKGROUND
It is unclear whether hysterotomy closure techniques can affect niche development. Therefore, this study aimed to analyze the effect of single-layer and double-layer interrupted closures of hysterotomy incisions during primary cesarean section on the formation of uterine niches.


METHODS
A prospective cohort study of women undergoing primary cesarean section was performed between June 2011 and July 2014. Saline contrast sonohysterography was used to measure the niche depth and residual myometrium. The ratio of the niche depth to the sum of the niche depth and residual myometrium thickness (niche ratio) was calculated.


RESULTS
Niches were identified in 14/58 (24.1%) women with single-layer sutures and 55/209 (26.3%) women with double-layer sutures (p = 0.74). Single-layer closure was associated with more than a five-fold increase in the odds of a niche ratio ≥0.4 (odds ratio 5.59; 95% CI 1.71-18.28).


CONCLUSIONS
Single-layer closure may be associated with an increased risk of larger niches (niche ratio ≥0.4), although it may not increase the overall frequency of niche formation.
Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
Soromon
http://orcid.org/0000-0001-7197-8258
S
Kataoka
Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
Fumie
F
Tanuma
Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
Yutaka
Y
Iwaki
Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
Kurumi
K
Iwaki
Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
Takeru
T
Fujii
Department of Obstetrics and Gynecology, Hakodate Central General Hospital, Hakodate, Japan.
Toshio
T
Fujimoto
D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects* / Q000379:methods; D002921:Cicatrix / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000009:adverse effects* / Q000379:methods; D016015:Logistic Models; D015999:Multivariate Analysis; D009215:Myometrium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology*; D011446:Prospective Studies; D013536:Suture Techniques / Q000009:adverse effects*
Cesarean section; cohort studies; hysterotomy; suture techniques; uterine rupture