الفهرس 
L OWER S EGMENT C ESAREAN S ECTIONOnly 14 pages are availabe for public view
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Abstract
Background: The recent rise in the number of cesarean deliveries had led to an increased number of patients suffering from the long-term morbidity from cesarean scars. There has been an increasing number of gynecologic complaints reported including postmenstrual spotting, dysmenorrhea, chronic pelvic pain and dyspareunia following cesarean delivery in recent years. Cesarean scar defects have also been associated with obstetric complications such as cesarean scar pregnancies, placental insertion abnormalities and uterine rupture in subsequent pregnancies.
Aim of the work: The aim of the study is to determine whether there is a difference in scar healing among patients undergoing single- or double layer unlocked suturing of their uterine incision during their primary caesarean delivery detected by measuring residual myometrial thickness (RMT) and healing ratio using saline infusion sonography 6 months postoperatively.
Methods: this randomized controlled trial was performed on 253 primigravida (100 in single layer group and 153 in double layer group) with full-term pregnancy that had Cesarean delivery and evaluation of uterine scar after 6 months of delivery by saline infusion sonography (SIS) at Ain Shams University hospitals with inclusion and exclusion criteria.
Results: Percentage of niche was significantly higher among single-layered group than among double-layered group. Operation duration was significantly longer among double-layered group than among single-layered group. Number of hemostatic sutures was higher in single-layered group but, not reaching the statistical significance. No significant difference between the studied groups regarding anterior total myometrial thickness. The residual myometrial thickness was significantly higher among double group than among single group. Healing ratio was significantly higher among double group than among single group.
Conclusion: As evident from the current study, the residual myometrial thickness was significantly higher among double group, operation duration was significantly longer among double-layered group than among single-layered group, Percentage of niche was significantly higher among single-layered group (65%) than among double-layered group (45%).
So, we concluded that double unlocked layers closure is associated with better uterine scar healing and higher RMT than single layer.