Impact of Methods for Uterine Incision Closure on Repeat Caesarean Section Scar of Lower Uterine Segment

Objective: To compare the effect of different suturing techniques in repeat caesarean section in terms of scar thickness, blood loss, operative time and scar dehiscence at the time of next caesarean section. Study Design: A randomized double blinded trial. Place and Duration of Study: Obstetrics and Gynaecology Department of Bahawal Victoria Hospital, Bahawalpur, from June 2005 to June 2010. Methodology: Ninety patients undergoing repeat caesarean section were included and randomly assigned to one of the three groups. Group A underwent one layer closure; Group B underwent two layer closure while Group C underwent modified two layer closure of the uterine incision. Ultrasonographic evaluation of the scar thickness was performed at 6 weeks post operatively and longer follow-up was done in next caesarean for scar dehiscence. Frequency percentages were obtained and compared using chi-square test with significance at p < 0.05 Results: In only 2 (6.6%) of modified two layer closure cases, it was necessary to use additional haemostatic sutures, compared with 16 (53%) of one layer closure group, and 10 (33%) of the two layer closure group. At 6 weeks, the mean scar thickness in group C (17.08 +/- 1.635 mm) was significantly greater (p < 0.001) as compared to group A (13.19 +/- 1.32 mm) and group B (14.58 +/- 1.18 mm). At long-term follow-up, only 1 (6%) case from group C showed the "uterine window" at the time of repeat caesarean section as compared to 3 (23%) in group A and 2 (14%) in group B. Conclusion: Scar thickness was significantly increased with modified two layer closure when compared with traditional one and two layer closure of lower transverse uterine incision at the time of repeat caesarean section.