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263571

Sonohysterographic Evaluation of Cesarean Scar Defect after Purse-String versus Double-Layer Uterine Closure Techniques: A Randomized Controlled Trial

Article

Last updated: 24 Dec 2024

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Abstract

Background: cesarean scar niche is one of the novels mentioned complications of cesarean section due to the rising numbers of cesarean sections and improved imaging modalities. The causes of cesarean scar niche are still being investigated, one of them is the uterine closure method that should be studied to pick up the best one to decrease the incidence of niche after cesarean delivery. Objective: The aim of this work was to find the best way of uterine closure decreasing the incidence of cesarean section niche. Material and methods:  A prospective randomized controlled study that was conducted between May 2021 and April 2022 at the department of Obstetrics and Gynecology, Zagazig University.Full term ninety-eight primigravida undergoing first elective cesarean section were equally randomized to either purse string or double-layer unlocked suture. Six months after cesarean section, Sonohysterography was done for assessment of cesarean scar integrity. Markers of cesarean scar healing included residual myometrial thickness "RMT", niche depth "D", hypoechoic triangular niche width "W" and healing ratio "D/RMT". All these markers were calculated by experienced sonographers who were not aware of the uterine closure technique. Results: In terms of estimated blood loss, there was no significant differences between both groups. However, frequency of appearance of niche in purse-string group was 25% compared to 56.8% in the double layer group (P=0.002). The mean thickness of the residual myometrium covering the defect was significantly higher 7.8 ± 1.1 mm after purse-string than 5.9 ± 0.6 mm after a double-layer closure (P = 0.001). The mean healing ratio in purse-string group was 0.449 versus 0.600 in the double-layer closure (p < 0.001). Conclusion: Purse-string uterine closure was associated with better uterine scar healing, higher residual myometrial thickness and lower rate of cesarean scar defect than double layer closure.  

DOI

10.21608/ejhm.2022.263571

Keywords

Niche, uterine Scar, Healing ratio, sonohysterography

Authors

First Name

Ahmed Ismail

Last Name

Heraiz

MiddleName

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Affiliation

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Email

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City

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Orcid

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First Name

Mohamed A.

Last Name

Ibrahem

MiddleName

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Affiliation

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Email

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City

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Orcid

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First Name

Basem

Last Name

hamed

MiddleName

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Affiliation

obstetrics and gynecology department, faculty of medicine, Zagazig University

Email

basem@zu.edu.eg

City

-

Orcid

0000-0001-9125-3051

Volume

89

Article Issue

1

Related Issue

36332

Issue Date

2022-10-01

Receive Date

2022-10-03

Publish Date

2022-10-01

Page Start

5,367

Page End

5,374

Print ISSN

1687-2002

Online ISSN

2090-7125

Link

https://ejhm.journals.ekb.eg/article_263571.html

Detail API

https://ejhm.journals.ekb.eg/service?article_code=263571

Order

192

Type

Original Article

Type Code

606

Publication Type

Journal

Publication Title

The Egyptian Journal of Hospital Medicine

Publication Link

https://ejhm.journals.ekb.eg/

MainTitle

Sonohysterographic Evaluation of Cesarean Scar Defect after Purse-String versus Double-Layer Uterine Closure Techniques: A Randomized Controlled Trial

Details

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Article

Created At

22 Jan 2023