Evaluation of the Effect of Two Different Types of Suture Patterns on Cesarean Scar Niche Formation in Elective Primary C.S | ||||
| The Egyptian Journal of Fertility and Sterility | ||||
| Volume 29, Issue 4 - Serial Number 11106352, July 2025, Page 112-120 PDF (279.49 K) | ||||
| Document Type: Original Article | ||||
| DOI: 10.21608/egyfs.2025.441444 | ||||
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| Authors | ||||
Abd El-Haseib Salah Saad1; Ahmed Nabil Abd El- Hamid1; Somaya Al-Sayed Abu-Alwafa2; Mohamed Zakaria Sayer Dayer  1
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| 1Department of Obstetrics and Gynecology, Faculty of Medicine, Menoufia University, Egypt | ||||
| 2Department of Obstetrics and Gynecology, Shebin El-Kom Teaching Hospital, Menoufia ,Egypt | ||||
| Abstract | ||||
| Background: Cesarean scar defects (CSDs) are a com-mon complications of cesarean sections, potentially lead-ing to various gynecological and obstetric issues. The impact of different uterine closure techniques on CSD formation remains debated. Aim: To evaluate the influences of uterine closure tech-niques (whether single layer or double layer closure) on the development of CSDs and to assess the diagnostic ac-curacy of ultrasound and saline infusion sonohysterogra-phy (SIS) in the detection of CSDs. Methods: A prospective randomized study included 140 women undergoing primary cesarean section, randomly assigned to single layer (n=70) or double layer (n=70) clo-sure groups. Transvaginal ultrasound and saline infusion sonohysterography (SIS) were performed at 3 months postoperatively to assess CSD characteristics. The prima-ry outcomes were CSDs formation rate and characteristics (length, depth, width and residual myometrial thickness) with regard to the uterine closure pattern. Secondary out-come included the diagnostic accuracy of ultrasound and SIS in the detection of CSDs. Results: Demographic and clinical characteristics were matched between the two studied groups. The single lay-er group had a significantly higher rate of CSDs forma-tion compared to the double layer group (64.3% versus 14.3%, p<0.001). In terms of CSDs characteristics among single layer group compared to double layer group, CSDs were significantly wider (5.65±1.18 vs 2.45±0.71 mm, p=0.037), deeper (4.35±0.69 vs 3.55±0.74 mm, p=0.041) with thinner residual myometrium (5.87±0.96 vs 7.99±0.99 mm, p=0.030). SIS demonstrated superi-or diagnostic accuracy (100%) compared to ultrasound (93.83%) for CSD detection. Conclusion: Double layer cesarean section closure tech-nique significantly reduces CSD occurrence and results in smaller defects with thicker residual myometrium com-pared to single layer suturing. SIS proves to be the most accurate method for CSD diagnosis and measurement. These findings suggest that adopting dou-ble-layer closure and using SIS for postop-erative evaluation could improve outcomes and management of cesarean scar defects. | ||||
| Keywords | ||||
| Cesarean section; uterine clo-sure; cesarean scar defect; single-layer; dou-ble-layer | ||||
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