Cesarean, Residual Myometrial Thickness, Cesarean Section, Repeated, Cesarean, Uterine Scar Thickness
Conditions
Brief summary
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.
Interventions
PROCEDURESingle layer closure
Uterine incision will be approximated with continuous unlocked suture, including a narrow band of the endometrial layer, without trimming incision edges.
PROCEDUREDouble layer closure
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.
PROCEDUREDoble layer closure with trimming
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.
Sponsors
Ataturk University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 50 Years
Healthy volunteers
Yes
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
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Residual myometrial thickness | 6 months after cesarean | Myometrial thickness at the uterine scar by transvaginal ultrasound |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Width of defect | 6 months after cesarean | In a sagittal plane, the width at base of defect |
| Depth of defect (niche) | 6 months after cesarean | In a sagittal plane, the distance from the base lining of the endometrium to the apex |
| Operation time | 10 minute after cesarean completed | Skin-to-skin operation time |
| Existence of cesarean scar defect | 6 months after cesarean | 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. |
| Blood product transfusion | One week after cesarean | Unite number of transfused packed erythrocyte |
| Maternal infectious morbidity | Six weeks after cesarean | Prevalence of postpartum endometritis, skin wound dehiscence and post operative fever. |
| Length of hospitalization | One month after cesarean | Duration in days |
| Change in hemoglobin | 48 hours after cesarean | Difference in haemoglobin measured preoperatively and postoperatively 48 hours |
Countries
Turkey (Türkiye)
Outcome results
None listed