The Impact of Uterine Incision Closure Technique on the Post Cesarean Residual Myometrial Thickness and Scar Defects. A Novel Technique at a Tertiary Care Hospital

Abstract Background: Cesarean delivery (CD) is considered as one of the commonest obstetric surgeries as it comprises about one fourth of all deliveries in developed countries and may be more over in developing countries. Aim of Study: To compare uterine incision closure with double layered first purse string, second continuous technique and double layered continuous non-locking technique during cesarean delivery (CD). Patients and Method: This prospective, randomized clin-ical study was conducted at Mansoura University Hospitals, Obstetrics and Gynecology Department between April 2017 and April 2018 and included 160 patients allocated for elective CD. All women included in the study were randomized into two equal groups; group 1 (study group) where a double layered first purse string, second continuous closure maneuver was used, group 2 (control group), where the traditional continuous non-locking technique was done. Detailed trans-vaginal ultrasound examination was planned for all patients 6 months after discharge. Uterine dimensions, the presence of intracavitary, parametrial and sub-vesical hematoma for-mation were recorded. The length of the incision was measured in transverse axis and recorded. The integrity of the incision was checked in transverse and longitudinal axis, a wedge-shaped distortion in the integrity of the uterine incision scar was accepted as uterine scar defect and recorded as primary outcome measure of the short-term results of the study. The height of the defect was also recorded. Results: Demographic data including age, gravidity, parity, body mass index was not significantly different between both groups. Also, operative time, hospitalstay, and preoperative as well as postoperative hemoglobin values were not signifi-cantly different between both groups. Uterine incision length after suturing is shorter in group 1 as in intraoperative meas-urements (p=<0.001, 95% CI=2.754-6.536). Significantly, the number of patients with ultra-sonographic visible uterine scar defects was 11 in the study group (32.35% of all scar defects) and 23 in the control group (67.65% of all scar defects; p=0.017; x2=5.647). The mean size of incisional defect is not significantly different between the groups.
Conclusions: The new technique introduced in the present study documented shorter uterine incision length and also lower frequency of uterine scar defect.