TITLE:
Effect of Single- versus Double-Layer Uterine Closure during Caesarean Section on Niche Formation and Menstrual Irregularity
AUTHORS:
Mohamed Samy, Esraa Hussein Fouad Ghoneimy, Walid Hitler
KEYWORDS:
Single-Layer, Double, Caesarean Section, Residual Myometrium Thickness
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.14 No.1,
January
18,
2024
ABSTRACT: Background: The myometrium at the location of the CS (caesarean section) scars, also
known as residual myometrium thickness (RMT), is larger after a double-layer
uterine closure procedure than following a single-layer one. It may lessen the
formation of a niche that is the myometrium’s disruption at the location of the
scar of the uterus. Gynecological manifestations, obstetric problems in a
future pregnancy and birth, and maybe subfertility are linked to thin RMT and a
niche. Objective: To ascertain if double-layer
unlocked closure of the uterus is better than single-layer one in terms of
post-menstrual spotting and niche development following a first CS. Patients and Methods: In this randomized clinical study, 287
patients were evaluated for qualifying. Of all eligible individuals, 57
patients were excluded from the study based on the inclusion criteria. Results: The variation in ages, gestational age, body mass index (BMI), and
cesarean section indications between the two assigned groups is statistically
insignificant. However, postmenstrual spotting was statistically significantly
more common in single-layer group compared to in double-group. The current
study revealed ultrasound findings suggestive of niche formation was
statistically significantly more common in single-layer group compared to in
double-layer group. Conclusion: As evident from the current study, it demonstrates
the advantages of double-layer unlocked closure of the uterus over single-layer
one in terms of post-menstrual spotting and niche development following
first-time cs. Thus, we deduced that fewer niches are formed, and fewer
menstrual spotting occurs in the presence of double unlocked layers closure. To
ascertain the impact of uterus closure method on post-operative niche
development and the risk of obstetrics and gynaecological problems, further
prospective trials with extended follow-up periods are required.