Effect of Single versus Double Layer Suturing of the Uterus on Uterine Healing and Formation of Scar Niche

Document Type : Original Article

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Obstetrics and Gynecology, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt

10.21608/aimj.2025.446534

Abstract

Background: It is common knowledge that every cesarean section(CS) results in the production of uterine scars; 50-70% of individuals experience a cesarean scar deformity as a result of inadequate tissue repair.
Aim and objectives: To evaluate the effect of two suture patterns used in closure of uterine incision during cesarean section and their role in CS niche formation in elective CS.
Patients and methods: The 88 pregnant women who participated in this prospective comparative randomized trial were split into two groups based on the pattern of sutures used to close the uterine incision after a cesarean section. From June to December of 2024, researchers from Al-Hussein and Bab Al-Sharya University Hospital's Obstetrics and Gynecology Department carried out the study.
Results: Fifty percent of patients in the single-layer group and 29.5% in the double-layer group had niche scars, a difference that was statistically significant (p=0.01). However, with a p-value of only 0.09, the median depth of the niche scar was 2.5 mm in the double-layer group and 1.8 mm in the single-layer group. The single-layer group had a median niche scar length of 4.6 mm, whereas the double-layer group had a median length of 2.9 mm (p=0.02). With a p-value of 0.001, the median niche width was 4.2 mm in the single-layer group and 1.9 mm in the double-layer group.
Conclusion: This study found that double-layer uterine closure result in less rates of niche formation, also it was associated with decrease in length and width of scar. While single-layer closure offered the advantage of shorter operative times, it did not appear to increase the risk of immediate postoperative complications in our sample.

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