Our Summary

This study compared three different surgical methods used to close the uterus during a Caesarean section (C-section). 120 patients were divided into three groups: one group had a traditional double-layer closure, the second group had a different type of double-layer closure called the Turan technique, and the third group had a new method we developed called the double-layer step up-step down technique.

Six weeks after the C-section, we used ultrasound to see how well the uterus had healed. We found that patients in the first group had a thinner layer of muscle (myometrium) at the site of the incision, and more of them had a small indent or “niche” at the scar site. The surgery also took longer for the second group.

Our conclusions are that the Turan technique and our new method result in a thicker layer of muscle and fewer “niches”, which are better outcomes. However, our new method has the added benefit of taking less time.

These findings are important because “niches” can lead to complications like ectopic pregnancy, where the fetus grows outside the uterus, or rupture of the uterus in a future pregnancy. More research is needed to see if these new methods can reduce the risk of uterine rupture in future pregnancies.

FAQs

  1. What were the three different surgical methods compared in the study for closing the uterus during a Caesarean section?
  2. What complications can arise from “niches” in the uterus after a C-section?
  3. Based on the study, which method of closing the uterus during a C-section resulted in better outcomes and took less time?

Doctor’s Tip

One helpful tip a doctor might tell a patient about cesarean section is to discuss with their healthcare provider the type of closure technique used during the surgery. Patients may want to inquire about the Turan technique or the double-layer step up-step down technique, as these methods have been shown to result in a thicker layer of muscle and fewer complications like “niches” at the scar site. This discussion could help patients make informed decisions about their future pregnancies and potential risks.

Suitable For

Patients who may be recommended for a cesarean section include those with:

  • Previous cesarean sections
  • Breech presentation
  • Multiple pregnancies (twins, triplets, etc.)
  • Placenta previa (when the placenta partially or completely covers the cervix)
  • Fetal distress
  • Maternal health conditions that make vaginal delivery risky
  • Previous uterine surgeries
  • Large baby or other factors that may make vaginal delivery difficult or dangerous

Timeline

  • Before the C-section: The patient will typically have a consultation with their healthcare provider to discuss the need for a C-section, reasons for the procedure, and potential risks and benefits. They may also undergo preoperative tests and preparations.

  • During the C-section: The patient will be given anesthesia, either spinal or epidural, to numb the lower half of their body. The surgeon will make an incision in the abdomen and uterus to deliver the baby. The baby is then born, and the surgeon will close the incisions in the uterus and abdomen.

  • After the C-section: The patient will be monitored in the recovery room for a few hours before being transferred to a postpartum room. They will receive pain medication and be encouraged to start moving around as soon as possible to prevent blood clots and promote healing. The patient will receive instructions on wound care, breastfeeding, and postoperative care before being discharged from the hospital.

  • Six weeks after the C-section: The patient may have a follow-up appointment with their healthcare provider to check on their recovery and well-being. In this study, ultrasound was used to assess the healing of the uterus and any potential complications. The findings showed that certain surgical techniques may result in better outcomes in terms of uterine healing and future pregnancy risks. More research is needed to further investigate these findings and their implications for patient care.

What to Ask Your Doctor

Some questions a patient should ask their doctor about cesarean section include:

  1. What surgical method will be used to close my uterus during the C-section?
  2. What are the potential risks and benefits of each surgical method?
  3. How long will the surgery take with the chosen method?
  4. What are the potential complications of having a thinner layer of muscle or a “niche” at the scar site?
  5. How likely is it that I may experience complications like ectopic pregnancy or uterine rupture in future pregnancies if a traditional double-layer closure is used?
  6. Does research support the use of alternative closure techniques like the Turan technique or the double-layer step up-step down technique?
  7. Are there any specific factors in my medical history that make one closure method more appropriate for me than another?
  8. How can I best care for my incision site after the C-section to promote healing and reduce the risk of complications?
  9. Will I need any additional monitoring or follow-up care due to the method used to close my uterus during the C-section?
  10. What steps can I take to reduce the risk of complications in future pregnancies, especially if I have had a C-section with a traditional double-layer closure?

Reference

Authors: Elkhouly NI, Abdelaal NK, Solyman AE, Elkelani OA, Elbasueny BF, Elhalaby AF. Journal: J Obstet Gynaecol. 2022 Apr;42(3):416-423. doi: 10.1080/01443615.2021.1910636. Epub 2021 Jun 22. PMID: 34155957