Effect of Single layer versus Double Layer Suturing on Healing of cesarean Uterine Scar: A Randomized controlled trial

Objective: Closing the uterine incision is a crucial aspect of a cesarean section. Therefore, it is essential to use a resilient surgical method that can withstand the pressure of subsequent labor. We aimed to assess the impact of single versus double-layer closure on residual myometrial thickness following cesarean section. Methods: This randomized controlled trial was conducted on 60 pregnant women scheduled for elective cesarean section at the operative theater of Ain Shams University Maternity Hospital from February to August 2021. We randomized the patients into two groups (30 in the single-layer group and 30 in the double-layer group) and had undergone cesarean delivery. The study evaluated their uterine scars using saline infusion sonography (SIS) three months after delivery. Results: No significant differences were observed between the two groups regarding hemoglobin drop, blood loss, procedure time, blood transfusion, and postoperative complications. However, the thickness of the residual myometrium covering the defect was significantly lower in the double-layer closure group compared to the single-layer closure group (4.70 ± 0.95 vs. 5.30 ± 1.15, respectively, P = 0.032). Conclusion: The single-layer unlocked closure is recommended over the double layer due to better uterine scar healing and higher RMT.