One vs Two-Layer Closure of the Uterine Wall Following Cesarean Section: Systematic Review Meta-Analysis of Randomized Control Trials

Background: Inappropriate healing of uterine scar after Cesarean section (CS) delivery is associated with adverse OB/GYN evetns. Recently, it was noticed that the incidence of CS increasing all over the world. Aim of the Work: We aim in our study at comparing two different techniques of uterine closure, one layer versus double-layer using ultrasound and comparing complication rates of CS and other outcomes. Material and Methods: We searched online databases such as (PubMed, Scopus, and WOS) for linked randomized clinical trials (RCTs). We conducted an online screening of the recalled articles, then related studies were incorporated in our meta-analysis (MA). Two types of data were encountered, the continuous type was expressed as mean difference and 95% confidence interval. On the other hand, dichotomous type of data was expressed as relative risk and 95% CI. Analysis done by Review Manager software (Version 5.4). Results: In our research, we used 18 RCTs. regarding myometrial thickness after aperation (MD was (1.15) and the 95% CI was (-1.69, -0.60), with the P-value =0.0001). regarding dys-menorrhea (RR was (1.36), and the 95% CI was (1.02, 1.81), with the P-value = 0.04), our results favored two layer uterine closure, however one layer closure had a shorterduration than two layer closure (MD was (-2.25), and the 95% CI was (-3.29, -1). Regarding uterine dehiscence, our results found that (RR was (1.88), and the 95% CI was (0.63, 5.62), with the P-value = 0.26), healing ratio (MD was (-5.00), and the 95% CI was(-12.40, 2.39), with the P-value = 0.18), maternal infection related morbidity (RR was (0.94), and the 95% CI was (0.66, 1.34), with the P-value equal 0.72), and the duration of hospital stay (MD was (-0.12), and the 95% CI (-0.30, 0.06) were comparable outcomes between the two procedures Conclusion: Two layer closure is superior to one layer closure of cesarean uterine scar in terms of RMT and dysmenorrhea. But one layer closure technique has the advantage over two layer closure in the shorter operation time.