A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness.
OBJECTIVE
We undertook a randomized clinical trial to examine the outcome of a single vs. a double layer uterine closure using ultrasound to assess uterine scar thickness.


METHODS
Participating women were allocated to one of three uterotomy suture techniques: continuous single layer unlocked suturing, continuous locked single layer suturing, or double layer suturing. Transvaginal ultrasound of uterine scar thickness was performed 6 weeks and 6 - 24 months after Cesarean delivery. Sonographers were blinded to the closure technique.


RESULTS
An "intent-to-treat" and "as treated" ANOVA analysis included 435 patients (n = 149 single layer unlocked suturing, n = 157 single layer locked suturing, and n = 129 double layer suturing). 6 weeks postpartum, the median scar thickness did not differ among the three groups: 10.0 (8.5 - 12.3 mm) single layer unlocked vs. 10.1 (8.2 - 12.7 mm) single layer locked vs. 10.8 (8.1 - 12.8 mm) double layer; (p = 0.84). At the time of the second follow-up, the uterine scar was not significantly (p = 0.06) thicker if the uterus had been closed with a double layer closure 7.3 (5.7 - 9.1 mm), compared to single layer unlocked 6.4 (5.0 - 8.8 mm) or locked suturing techniques 6.8 (5.2 - 8.7 mm). Women who underwent primary or elective Cesarean delivery showed a significantly (p = 0.03, p = 0.02, "as treated") increased median scar thickness after double layer closure vs. single layer unlocked suture.


CONCLUSIONS
A double layer closure of the hysterotomy is associated with a thicker myometrium scar only in primary or elective Cesarean delivery patients.
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Christian
C
Bamberg
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Joachim W
JW
Dudenhausen
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Verena
V
Bujak
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Elke
E
Rodekamp
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Martin
M
Brauer
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Larry
L
Hinkson
Maternal-Fetal Medicine, Obstetrics & Gynecology Department, Sidra Medical and Research Center, Doha, Qatar.
Karim
K
Kalache
Department of Obstetrics, Charité-University Medical Center, Berlin, Germany.
Wolfgang
W
Henrich
D002585:Cesarean Section; D002921:Cicatrix; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000379:methods; D011247:Pregnancy; D011446:Prospective Studies; D014599:Uterus / Q000000981:diagnostic imaging / Q000473:pathology