Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single‐ or double‐layer uterotomy closure: a randomized controlled trial. (21st September 2017)

• Record Type: Journal Article
• Authors: Bamberg, Christian; Hinkson, Larry; Dudenhausen, Joachim W.; Bujak, Verena; Kalache, Karim D.; Henrich, Wolfgang
• Is Part Of: Acta obstetricia et gynecologica Scandinavica. Volume 96:Number 12(2017)
• Page Start: 1484
• Page End: 1489
• Publication Date: 2017-09-21
• Subjects: Cesarean delivery -- cesarean scar defect -- double‐layer closure -- isthmocele -- niche -- pouch -- single‐layer closure -- suture technique; Gynecology -- Periodicals; Pregnancy -- Periodicals; Obstetrics -- Periodicals; 618.05
• DOI: 10.1111/aogs.13213
• Languages: English
• ISSNs: 0001-6349

Abstract

Abstract: Introduction: Cesarean deliveries are the most common abdominal surgery procedure globally, and the optimal way to suture the hysterotomy remains a matter of debate. The aim of this study was to assess the incidence of cesarean scar niches and the depth after single‐ or double‐layer uterine closure. Material and methods: We performed a randomized controlled trial in which women were allocated to three uterotomy suture techniques: continuous single‐layer unlocked, continuous locked single‐layer, or double‐layer sutures. Transvaginal ultrasound was performed six weeks and 6–24 months after cesarean delivery [Clinicaltrials.gov (NCT02338388)]. Results: The study included 435 women. Six weeks after delivery, the incidence of niche was not significantly different between the groups ( p = 0.52): 40% for single‐layer unlocked, 32% for single‐layer locked and 43% for double‐layer sutures. The mean ± SD niche depths were 3.0 ± 1.4 mm for single‐layer unlocked, 3.6 ± 1.7 mm for single‐layer locked and 3.3 ± 1.3 mm for double‐layer sutures ( p = 1.0). There were no significant differences ( p = 0.58) in niche incidence between the three groups at the second ultrasound follow up: 30% for single‐layer unlocked, 23% for single‐layer locked and 29% for double‐layer sutures. The mean ± SD niche depth was 3.1 ± 1.5 mm after single‐layer unlocked, 2.8 ± 1.5 mm after single‐layer locked and 2.5 ± 1.2 mm after double‐layer sutures ( p = 0.61). There was a trend ( p = 0.06) for the residual myometrium thickness to be thicker after double‐layer repair at the long‐term follow up. Conclusions: The incidence of cesarean scar niche formation and the niche depth was independent of the hysterotomy closure technique.