Thinned-out Lower Uterine Segment Scar Previous Cesarean Section
Conditions
Keywords
Cesarean Section, Repeat Cesarean Section
Brief summary
Brief Summary The goal of this clinical trial is to compare the effectiveness of purse-string suture versus transverse mattress suture for achieving hemostasis in women with thinned-out lower uterine segment scars undergoing repeat cesarean section. The study aims to determine whether the purse-string suture technique provides faster and more effective hemostasis than the transverse mattress suture technique. The main questions it aims to answer are: * Does the purse-string suture reduce the time required to achieve hemostasis compared with the transverse mattress suture? * Does the purse-string suture reduce the number of additional sutures required to achieve adequate hemostasis? Researchers will compare purse-string suturing with transverse mattress suturing to determine which technique achieves hemostasis more efficiently in women with thinned-out cesarean section scars. Participants will: * Undergo repeat cesarean section under standard surgical care. * Be randomly assigned to receive either purse-string suturing or transverse mattress suturing for repair of the thinned-out lower uterine segment after closure of the first uterine layer. * Have the time required to achieve hemostasis and the number of sutures required recorded intraoperatively. * Receive routine postoperative management according to institutional protocols. Suggested improvement Although the thesis mentions only time to achieve hemostasis and number of sutures as outcomes, ClinicalTrials.gov prefers that the primary outcome be clearly identified. Since your sample size was calculated using time to achieve hemostasis, I recommend presenting it as: * Primary outcome: Time to achieve hemostasis (minutes) * Secondary outcomes: Number of sutures required for hemostasis; duration of cesarean section (minutes)
Interventions
PROCEDUREPurse-String Suture
Purse-string suturing of the thinned-out lower uterine segment during repeat cesarean section.
PROCEDURETransverse Mattress Suture
Transverse mattress suturing of the thinned-out lower uterine segment during repeat cesarean section.
Sponsors
Natasha Bushra
Lahore General Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
18 Years to 40 Years
Healthy volunteers
No
Inclusion criteria
* Females aged 18 to 40 years. * Gestational age \>37 weeks at the time of delivery. * Parity \<5. * History of one or more previous cesarean sections. * Intraoperative evidence of a thinned-out lower uterine segment scar during repeat cesarean section.
Exclusion criteria
* Preeclampsia (blood pressure ≥140/90 mmHg with proteinuria \>+1 on dipstick). * Gestational diabetes mellitus. * Placental abnormalities, including placenta previa, placenta accreta spectrum (accreta/increta), or placental abruption. * Previous uterine repair scar. * Coagulation disorder (prothrombin time \>15 seconds).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Time to Achieve Hemostasis | During the surgical procedure (intraoperative) | Time (in minutes) required to achieve complete hemostasis of the thinned-out lower uterine segment following application of the assigned suturing technique during repeat cesarean section. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Sutures Required to Achieve Hemostasis | Intraoperative (during cesarean section) | Number of hemostatic sutures required to achieve complete hemostasis of the thinned-out lower uterine segment during repeat cesarean section. |
Countries
Pakistan
Outcome results
None listed