Uterine Caesarean Closure Techniques Affect Ultrasound Findings and Maternal Outcomes: a Systematic Review and Meta-Analysis

S I Stegwee, I P M Jordans, L F van der Voet, P M van de Ven, J C F Ket, C B Lambalk, C J M de Groot, W J K Hehenkamp, J A F Huirne

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BACKGROUND: Caesarean section (CS) rates are rising globally. Long-term adverse outcomes after CS might be reduced when the optimal uterine closure technique becomes evident.

OBJECTIVE: To determine the effect of uterine closure techniques after CS on maternal and ultrasound outcomes.

SEARCH STRATEGY: Literature search in electronic databases.

SELECTION CRITERIA: Randomised controlled trials (RCTs) or prospective cohort studies that evaluated uterine closure techniques and reported on ultrasound findings, perioperative or long-term outcomes.

DATA COLLECTION AND ANALYSIS: 20 studies (15053 women) were included in our meta-analyses for various outcomes. We calculated pooled risk ratio's (RR) with 95% CI through random-effect analysis.

MAIN RESULTS: Residual myometrium thickness (RMT), reported in eight studies (508 women), decreased with 1.26 mm after single- compared to double-layer closure (95% CI: -1.93 - -0.58), particularly when locked sutures were used. Healing ratio (RMT/adjacent myometrium thickness (AMT)) diminished after single-layer closure (WMD -7.74%, 95% CI: -13.31 - -2.17), particularly in case of locked sutures. Niche prevalence increased (RR 1.71, 95% CI: 1.11 - 2.62) when the decidua was excluded. Dysmenorrhea occurred more often in the single-layer group (RR 1.23, 95% CI: 1.01 - 1.48), whereas incidence of uterine rupture was similar (RR 1.91, 95% CI: 0.63 - 5.74).

CONCLUSION: Double-layer unlocked sutures are favorable over single-layer locked sutures concerning RMT, healing ratio and dysmenorrhea. Excluding the decidua seems to result in higher niche prevalence. Since thin residual myometrium or niches may serve as intermediates for gynaecological and reproductive outcomes, future studies should focus on these outcomes. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)1097-1108
Number of pages12
JournalBJOG: An International Journal of Obstetrics & Gynaecology
Issue number9
Early online date7 Dec 2017
Publication statusPublished - 1 Aug 2018

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