Cesarean delivery accounts for approximately 30% of deliveries in Canada. A cesarean
scar defect (CSD), or isthmocele, is a myometrial defect ≥2 mm in depth at the cesarean
scar site that can lead to major obstetrical and gynaecological complications.
1
Although CSD treatments exist, interest has shifted to prevention, with suture technique
being the most modifiable risk factor. Some studies have suggested a double-layer
closure decreases CSD formation and increases residual myometrial thickness,
2
but systematic reviews have suggested no difference between a single versus double-layer
closure.
3
However, a locked suture may result in a larger CSD with a higher risk of uterine
rupture, without hemostatic benefit.
3
We therefore hypothesized that an unlocked double-layer closure may prevent CSD formation.
As such, our objective was to assess the feasibility of a pilot randomized controlled
trial (RCT) comparing locked versus unlocked first layer cesarean scar closure.To read this article in full you will need to make a payment
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References
- Emerging manifestations of cesarean scar defect in reproductive-aged women.J Minim Invasive Gynecol. 2016; 23: 893-902
- Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial.Am J Obstet Gynecol. 2016; 214: 507.e1-507.e6
- Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis.Am J Obstet Gynecol. 2014; 211: 453-460
Article info
Publication history
Published online: August 12, 2022
Identification
Copyright
© 2022 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
