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The study compares three techniques of uterine closure on myometrium thickness at the site of uterine scar of women who underwent repeated cesarean section. Cesarean scar will be evaluated by transvaginal ultrasound six months after cesarean.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Single layer closure | Active Comparator |
| |
| Double layer closure | Active Comparator |
| |
| Doble layer closure with trimming | Active Comparator |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Single layer closure | Procedure | Uterine incision will be approximated with continuous unlocked suture, including a narrow band of the endometrial layer, without trimming incision edges. |
| Measure | Description | Time Frame |
|---|---|---|
| Residual myometrial thickness | Myometrial thickness at the uterine scar by transvaginal ultrasound | 6 months after cesarean |
| Measure | Description | Time Frame |
|---|---|---|
| Existence of cesarean scar defect | The presence or absence of a cesarean scar defect that was defined as any unechogenic area visualised by transvaginal ultrasound at the site of the cesarean scar with a depth of at least 2 mm. | 6 months after cesarean |
| Width of defect |
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Inclusion Criteria:
Exclusion Criteria:
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Ataturk University Hospital | Erzurum | Turkey (Türkiye) |
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| Double layer closure | Procedure | The first layer suture penetrated the whole thickness of the uterine wall, including a narrow band of the endometrial layer. Second layer sture is acontinous sture performed in a lateral-to lateral position , imbricating first layer. |
|
| Doble layer closure with trimming | Procedure | Uterine incision will be trimmed and old scar tissue will be removed. The first layer suture penetrated the whole thickness of the uterine wall, including a narrow band of the endometrial layer. Second layer sture is acontinous sture performed in a lateral-to lateral position , imbricating first layer. |
|
In a sagittal plane, the width at base of defect |
| 6 months after cesarean |
| Depth of defect (niche) | In a sagittal plane, the distance from the base lining of the endometrium to the apex | 6 months after cesarean |
| Operation time | Skin-to-skin operation time | 10 minute after cesarean completed |
| Change in hemoglobin | Difference in haemoglobin measured preoperatively and postoperatively 48 hours | 48 hours after cesarean |
| Blood product transfusion | Unite number of transfused packed erythrocyte | One week after cesarean |
| Maternal infectious morbidity | Prevalence of postpartum endometritis, skin wound dehiscence and post operative fever. | Six weeks after cesarean |
| Length of hospitalization | Duration in days | One month after cesarean |