Ultrasound evaluation of Cesarean scar after single‐ and double‐layer uterotomy closure: a cohort study

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Abstract
Objectives: To compare residual myometrial thickness (RMT) and size of the Cesarean scar defect after single‐ and double‐layer uterotomy closure following first elective Cesarean section.Methods: A retrospective cohort study was conducted in 149 women at least 6 months after an uncomplicated, elective Cesarean delivery. Two‐dimensional transvaginal ultrasonographic measures of RMT, scar defect depth, width and length and myometrial thickness adjacent to the scar were compared in 68 women with single‐layer and 81 women with double‐layer closure delivered before and after, respectively, a change in the surgical procedure. Outcomes between the two groups were compared.Results: Median RMT was 5.8 (interquartile range (IQR), 4.1–7.8) mm in women with double‐layer closure vs 4.6 (IQR, 3.4–6.5) mm in those with single‐layer closure (P = 0.04). Scar defect length was greater in women with single‐layer closure (median, 6.8 (IQR, 4.4–8.5) mm) than in those with double‐layer closure (median, 5.6 (IQR, 3.9–6.8) mm) (P = 0.01). Measurements of defect depth and width, and the proportion of scars with RMT < 2.3 mm were similar in the two groups.Conclusions: RMT was greater and defect length, but not defect depth and width, was smaller following double‐layer compared with single‐layer closure, which may indicate some limited benefit of double‐layer closure following first elective Cesarean section. Copyright © 2013 ISUOG. Published by John Wiley & Sons Ltd.

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