Demirdağ Erhan, Kutlucan Hazal, Tutal Anıl Doğukan, Çalişkan Keskinsoy Bilge Pınar, Karakuyu Gülşah, Karabacak Recep Onur
Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkiye.
Department of Obstetrics and Gynecology, Faculty of Medicine, TOBB Economy and Technology University, Ankara, Turkiye.
Turk J Med Sci. 2024 Nov 5;54(6):1244-1251. doi: 10.55730/1300-0144.5906. eCollection 2024.
BACKGROUND/AIM: Cesarean section (CS) is a widely performed operation worldwide but data about uterine closure are lacking. We aimed to evaluate scar niches and compare single-layer and double-layer uterine closure at 6 months following CS.
This prospective randomized trial assessed 56 women undergoing single- or double-layer uterine closure. None of the patients had previous uterine surgery and all CS cases were elective. Transvaginal ultrasound was performed 6 months after CS to assess the uterine scars by measuring the width, depth, and length of the scar niche and residual myometrial thickness. An experienced sonographer was blinded to the uterine closure technique and the ultrasounds were conducted by practitioners unaware of the technique in the postoperative follow-up appointments.
Twenty-eight women were assigned to the single-layer closure group (Group 1) and 28 were assigned to the double-layer closure group (Group 2). The demographic and clinical characteristics of patients and the width, depth and diameter of the niche were similar between the groups, as was residual myometrial thickness. There was no difference in uterine scar volume under the incision between the two groups. The duration of surgery was approximately 5 min longer (p = 0.048) and hemoglobin decrease was about 0.5 g/dL less (p = 0.039) in the double-layer group compared to the single-layer group. Postmenstrual spotting rates were similar between the groups. Group 1 had two and Group 2 had one spontaneous pregnancy within 6 months after CS.
The single- and double-layer closure techniques do not produce different impacts on CS niche features at 6 months after delivery. Ultrasound might be an important noninvasive diagnostic tool for understanding CS scar remodeling.
背景/目的：剖宫产术（CS）在全球范围内广泛开展，但缺乏关于子宫缝合的数据。我们旨在评估瘢痕憩室，并比较剖宫产术后6个月时单层和双层子宫缝合的情况。
这项前瞻性随机试验评估了56例行单层或双层子宫缝合的女性。所有患者既往均未接受过子宫手术，且所有剖宫产病例均为择期手术。剖宫产术后6个月进行经阴道超声检查，通过测量瘢痕憩室的宽度、深度和长度以及剩余肌层厚度来评估子宫瘢痕。一名经验丰富的超声检查医师对子宫缝合技术不知情，超声检查由术后随访时不了解该技术的医生进行。
28名女性被分配到单层缝合组（第1组），28名被分配到双层缝合组（第2组）。两组患者的人口统计学和临床特征以及憩室的宽度、深度和直径相似，剩余肌层厚度也相似。两组切口下子宫瘢痕体积无差异。与单层组相比，双层组手术时间约长5分钟（p = 0.048），血红蛋白下降约少0.5 g/dL（p = 0.039）。两组月经后点滴出血率相似。第1组在剖宫产术后6个月内有2例自然妊娠，第2组有1例。
单层和双层缝合技术在分娩后6个月对剖宫产瘢痕特征没有不同影响。超声可能是了解剖宫产瘢痕重塑的重要非侵入性诊断工具。
