Explore the long-term outcomes of single versus double-layer suturing in cesarean sections and how it impacts maternal health in our deep dive into the 2Close study’s 3-year follow-up results.
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Single- versus double-layer uterine closure during cesarean section: 3-year follow-up of a randomized controlled trial (2Close study).
Verberkt et al., Am J Obstet Gynecol 2023
DOI: 10.1016/j.ajog.2023.12.032
Study on Uterine Closure Techniques After Cesarean Section and Their Impact on Reproductive Outcomes
Background: The increase in cesarean sections (CS) has led to more cases of niche formation in the uterine scar, which can cause gynecological issues and complications in later pregnancies. The impact of single- versus double-layer uterine closure techniques on these outcomes is unclear.
Methods: A multicenter, double-blind, randomized controlled trial (the 2Close study) was conducted in the Netherlands, involving 2292 women undergoing their first CS. They were randomly assigned to either single-layer or double-layer uterine incision closure. The primary outcome measured was the live birth rate after 3 years, with secondary outcomes including pregnancy rate, fertility treatment necessity, delivery mode, and obstetric and gynecologic complications.
Results: Out of the participants, 830/1144 in the single-layer group and 818/1148 in the double-layer group responded to the 3-year follow-up questionnaire. No significant differences were found between the two groups in terms of live birth rates, pregnancy rates, fertility treatments, delivery modes, or uterine ruptures in subsequent pregnancies. Both groups reported high rates of gynecological symptoms such as spotting (30-32%), dysmenorrhea (47-49%), and sexual dysfunction (FSFI score 23).
Conclusion: The study found no evidence that double-layer closure is superior to single-layer closure regarding reproductive outcomes after a first CS. This finding challenges the current preference for double-layer closure, suggesting that surgeons may choose their preferred method. The study also highlights the importance of informing patients about the potential for gynecological symptoms following a CS.
Significance: This research contributes to the ongoing debate about the optimal uterine closure technique after CS, providing evidence that may influence surgical practices and patient counseling.