Impact of adding a second-layer to a single unlocked closure of Cesarean uterine incision: a randomized controlled trial

OBJECTIVE: The purpose of the present study was to investigate short- and long term effects on residual myometrial thickness (RMT) by adding a second-layer to a single unlocked closure of caesarean uterine incision.

METHOD: he study was a randomized double-blind controlled trial. Healthy nulliparous scheduled for first-time elective Caesarean delivery were operated using a modified version of the Misgav-Ladach surgical technique. The women were examined by abdominal ultrasound before discharge from the maternity ward and by hysterosonography five months post partum.

RESULTS: Seventy-six nulliparous met the criteria and accepted participation. Thirty-eight women were assigned to single-layer and 38 to double-layer unlocked closure technique. Groups were comparable regarding gestational age at delivery, duration of surgery and peroperative blood loss. RMT was without difference between the two groups, both at discharge (20.2±8.0 mm vs. 21.0±9.7 mm (mean±sd)) and five months postpartum (5.7±2.9 mm vs. 5.7±2.2 mm (mean±sd)). RMT was about half that of the normal myometrium at both examinations.

CONCLUSION: The present results suggest that double-layer closure of the caesarean uterine incision does not increase RMT compared to single-layer closure when an unlocked technique is used.