Comparing Cesarean Scar Defect Incidence After Locked and Unlocked Repair Methods Among Primiparous Patients: A Randomized Double-Blinded Trial.

Journal of Family and Reproductive Health Pub Date : 2024-09-01 DOI:10.18502/jfrh.v18i3.16655

Azadeh Tarafdari, Mahdieh Nazarpour, Nikan Zargardzadeh, Sedigheh Hantoushzadeh, Mohammadamin Parsaei

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Abstract

Objective: To compare residual myometrial thickness (RMT) and cesarean scar defect (CSD) development after cesarean section using double-layer locked and unlocked closure techniques.

Materials and methods: We conducted a randomized double-blinded trial comparing double-layer locked and unlocked uterine closure techniques following cesarean section in primiparous women. The locked technique involved continuous suturing of the full myometrial thickness in the first layer, followed by back-and-forth needle maneuvering on both sides of the incision for the second layer. The unlocked method included running suturing of two-thirds of the myometrial thickness in the first layer, followed by suturing the upper half of the myometrial thickness in the second layer. Transvaginal ultrasonography was performed one year post-cesarean section, with RMT as the primary outcome and scar depth and width as secondary outcomes. Independent t-test and Chi-square test were utilized for statistical analysis.

Results: All 30 patients from the locked and 26 from the unlocked group in the follow-up were diagnosed with CSD (scar depth>2mm). The mean RMT for the unlocked and locked groups were 4.44±1.07mm and 4.12±0.48mm, respectively, showing no significant difference (p =0.14). There was also no significant difference in mean scar width between the locked and unlocked groups (3.68±1.44mm vs. 3.95±1.00mm, p =0.42). However, the mean scar depth was higher in the unlocked group (3.77±1.11 mm vs. 3.16±1.1mm, p =0.04).

Conclusion: We have found no significant differences in the RMT and CSD prevalence between two-layered locked and unlocked uterine closure techniques, while the scar depth was greater in the unlocked group. Nonetheless, future randomized trials implementing larger sample sizes are required to precisely compare the outcomes of the double-layer locked and unlocked uterine suturing techniques.

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比较初产妇采用锁定和非锁定修复方法后的剖宫产瘢痕缺陷发生率：随机双盲试验。

摘要比较使用双层锁定和无锁定闭合技术进行剖宫产术后残余子宫肌层厚度（RMT）和剖宫产瘢痕缺损（CSD）的发展情况：我们进行了一项随机双盲试验，比较了初产妇剖宫产术后双层锁定和无锁定子宫闭合技术。锁定技术包括连续缝合第一层的全部子宫肌层厚度，然后在切口两侧来回移动针头缝合第二层。非锁定法包括连续缝合第一层子宫肌层厚度的三分之二，然后缝合第二层子宫肌层厚度的上半部分。剖宫产术后一年进行经阴道超声检查，RMT为主要结果，疤痕深度和宽度为次要结果。统计分析采用独立 t 检验和卡方检验：随访中，锁定组的 30 名患者和解锁组的 26 名患者均被诊断为 CSD（瘢痕深度大于 2 毫米）。解锁组和锁定组的平均 RMT 分别为（4.44±1.07）mm 和（4.12±0.48）mm，无显著差异（P =0.14）。锁定组和解锁组的平均疤痕宽度也无明显差异（3.68±1.44mm vs. 3.95±1.00mm，p =0.42）。然而，解锁组的平均疤痕深度更高（3.77±1.11 mm vs. 3.16±1.1mm，p =0.04）：结论：我们发现双层锁定和无锁定子宫闭合术在RMT和CSD发生率上无明显差异，而无锁定组的瘢痕深度更大。尽管如此，未来仍需进行样本量更大的随机试验，以准确比较双层锁定和无锁定子宫缝合技术的结果。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Family and Reproductive Health

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审稿时长

5 weeks

期刊介绍： The Journal of Family & Reproductive Health (JFRH) is the quarterly official journal of Vali–e–Asr Reproductive Health Research Center. This journal features fulllength, peerreviewed papers reporting original research, clinical case histories, review articles, as well as opinions and debates on topical issues. Papers published cover the scientific and medical aspects of reproductive physiology and pathology including genetics, endocrinology, andrology, embryology, gynecologic urology, fetomaternal medicine, oncology, infectious disease, public health, nutrition, surgery, menopause, family planning, infertility, psychiatry–psychology, demographic modeling, perinatalogy–neonatolgy ethics and social issues, and pharmacotherapy. A high scientific and editorial standard is maintained throughout the journal along with a regular rate of publication. All published articles will become the property of the JFRH. The editor and publisher accept no responsibility for the statements expressed by the authors here in. Also they do not guarantee, warrant or endorse any product or service advertised in the journal.