Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: Comparison of two types of single-layer suture

Aim: A common anatomical consequence of low-segment cesarean section is the presence of a pouch on the anterior uterine wall that can be detected by sonography or hysteroscopy. Different suturing techniques have been compared (single vs double layer) and showed no substantial differences. This prospective longitudinal study was aimed at evaluating the outcome of the cesarean scar, comparing two different types of single-layer sutures by transvaginal ultrasound and hysteroscopy. Material and Methods: The study sample consisted of two groups of 30 singleton primiparae at term who delivered by elective low segment cesarean section. In the first group, uterine closure was done with locked continuous single-layer sutures and in the second group, with single-layer interrupted sutures. Patients were assessed by transvaginal ultrasound and hysteroscopy, between the 6th and the 12th month after delivery, and again at the 24th month. Ultrasound measurements were made of the pouch area, if present. Results: A bell-shaped uterine wall defect was seen at ultrasound in 36 (85.71%) of 42 patients who completed the follow up at the 24th month. It was larger in the group of patients with closure by continuous sutures (6.2 [2.1-14.7] mm(2)) as compared to interrupted sutures (4.6 [1.9-8.2] mm(2), P = 0.03). Hysteroscopy confirmed the presence of the wall defect in all 36 cases, but different hysteroscopic outcomes were observed. Conclusion: Locked continuous sutures seem to cause a larger defect as compared to interrupted sutures, probably due to a greater ischemic effect exerted on the uterine tissue.