Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2024 May;309(5):2063-2070.
doi: 10.1007/s00404-024-07417-1. Epub 2024 Mar 18.

The association of endometrial closure during cesarean section to the risk of developing uterine scar defect: a randomized control trial

Aya Mohr-Sasson  1   2 , Elias Castel  3   4 , Tal Dadon  3 , Ariel Brandt  3 , Roie Etinger  3 , Adiel Cohen  3 , Michal Zajicek  3   4 , Jigal Haas  3   4 , Roy Mashiach  3   4
Affiliations
Randomized Controlled Trial

The association of endometrial closure during cesarean section to the risk of developing uterine scar defect: a randomized control trial

Aya Mohr-Sasson et al. Arch Gynecol Obstet. 2024 May.

Abstract

Purpose: The surgical technique for uterine closure following cesarean section influences the healing of the cesarean scar; however, there is still no consensus on the optimal technique regarding the closure of the endometrium layer. The aim of this study was to compare the effect of closure versus non-closure of the endometrium during cesarean section on the risk to develop uterine scar defect and associated symptoms.

Methods: A randomized prospective study was conducted of women undergoing first elective cesarean section at a single tertiary medical center. Exclusion criteria included previous uterine scar, preterm delivery and dysmorphic uterus. Women were randomized for endometrial layer closure versus non-closure. Six months following surgery, women were invited to the ambulatory gynecological clinic for follow-up visit. 2-D transvaginal ultrasound examination was performed to evaluate the cesarean scar characteristics. In addition, women were evaluated for symptoms that might be associated with uterine scar defect. Primary outcome was defined as the residual myometrial thickness (RMT) at the uterine cesarean scar. Data are presented as median and interquartile range.

Results: 130 women were recruited to the study, of them follow-up was achieved in 113 (86.9%). 61 (54%) vs. 52 (46%) of the women were included in the endometrial closure vs. non-closure groups, respectively. Groups were comparable for patient's demographic, clinical characteristics and follow-up time for postoperative evaluation. Median RMT was 5.3 (3.0-7.7) vs. 4.6 (3.0-6.5) mm for the endometrial closure and non-closure groups, respectively (p = 0.38). Substantially low RMT (< 2.5 mm) was measured in four (6.6%) women in the endometrial closure group and three (5.8%) of the women in the non-closure group (p = 0.86). All other uterine scar sonographic measurements, as well as dysmenorrhea, pelvic pain and intermenstrual bleeding rates were comparable between the groups.

Conclusion: Closure versus non-closure of the endometrial layer during cesarean uterine incision repair has no significant difference in cesarean scar characteristics and symptom rates at 6 months follow-up.

Keywords: Cesarean scar defect; Dysmenorrhea; Endometrial layer; Intermenstrual bleeding; Residual myometrial thickness.

PubMed Disclaimer

References

    1. Mathai M, Hofmeyr GJ, Mathai NE (2013) Abdominal surgical incisions for caesarean section. Cochrane Database Syst Rev 5:CD004453
    1. Wang CB, Chiu WW, Lee CY, Sun YL, Lin YH, Tseng CJ (2009) Cesarean scar defect: correlation between Cesarean section number, defect size, clinical symptoms and uterine position. Ultrasound Obstet Gynecol 34(1):85–89 - DOI - PubMed
    1. Tulandi T, Cohen A (2016) Emerging manifestations of cesarean scar defect in reproductive-aged women. J Minim Invasive Gynecol 23(6):893–902 - DOI - PubMed
    1. van der Voet LF, Bij de Vaate AM, Veersema S, Brölmann HA, Huirne JA (2014) Long-term complications of caesarean section. The niche in the scar: a prospective cohort study on niche prevalence and its relation to abnormal uterine bleeding. BJOG 121(2):236–244 - DOI - PubMed
    1. Mohr-Sasson A, Dadon T, Brandt A, Shats M, Axcelrod M, Meyer R et al (2023) The association between uterine scar defect (niche) and the presence of symptoms. Reprod Biomed Online 47:103221 - DOI - PubMed

Publication types

LinkOut - more resources