Evaluation of Cesarean Scar After Three Different Uterine Closure Technis

Ataturk University90 enrolled

Overview

The study compares three techniques of uterine closure on myometrium thickness at the site of uterine scar of women who underwent repeated cesarean section. Cesarean scar will be evaluated by transvaginal ultrasound six months after cesarean.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

DOUBLE

Enrollment

Conditions

Cesarean Section, Repeated Cesarean, Uterine Scar Thickness Cesarean, Residual Myometrial Thickness

Interventions

Single layer closurePROCEDURE

Uterine incision will be approximated with continuous unlocked suture, including a narrow band of the endometrial layer, without trimming incision edges.

Double layer closurePROCEDURE

The first layer suture penetrated the whole thickness of the uterine wall, including a narrow band of the endometrial layer. Second layer sture is acontinous sture performed in a lateral-to lateral position , imbricating first layer.

Doble layer closure with trimmingPROCEDURE

Uterine incision will be trimmed and old scar tissue will be removed. The first layer suture penetrated the whole thickness of the uterine wall, including a narrow band of the endometrial layer. Second layer sture is acontinous sture performed in a lateral-to lateral position , imbricating first layer.

Eligibility

Sex: FEMALEMin age: 18 YearsMax age: 50 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: * Previous two or three cesarean * Gestational weeks \>=36 weeks Exclusion Criteria: * Risk of obstetric haemorrhage * Suspicion or diagnosis placenta previa or accrete syndrome * Chorioamnionitis * Uterine myoma in the anterior uterine segment * Hysterotomy other than lower segment uterine incision at previous cesarean

Locations (1)

Ataturk University Hospital

Erzurum, Turkey (Türkiye)

Outcomes

Primary Outcomes

Residual myometrial thickness

Myometrial thickness at the uterine scar by transvaginal ultrasound

Time frame: 6 months after cesarean

Secondary Outcomes

Existence of cesarean scar defect

The presence or absence of a cesarean scar defect that was defined as any unechogenic area visualised by transvaginal ultrasound at the site of the cesarean scar with a depth of at least 2 mm.

Time frame: 6 months after cesarean

Width of defect

In a sagittal plane, the width at base of defect

Time frame: 6 months after cesarean

Depth of defect (niche)

In a sagittal plane, the distance from the base lining of the endometrium to the apex

Time frame: 6 months after cesarean

Operation time

Skin-to-skin operation time

Time frame: 10 minute after cesarean completed

Change in hemoglobin

Difference in haemoglobin measured preoperatively and postoperatively 48 hours

Time frame: 48 hours after cesarean

Blood product transfusion

Unite number of transfused packed erythrocyte

Time frame: One week after cesarean

Maternal infectious morbidity

Prevalence of postpartum endometritis, skin wound dehiscence and post operative fever.

Data from ClinicalTrials.gov

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