Archives of Gynecology and Obstetrics

, Volume 297, Issue 5, pp 1137–1143 | Cite as

Evaluation of cesarean scar after single- and double-layer hysterotomy closure: a prospective cross-sectional study

  • Nur Betül Tekiner
  • Berna Aslan Çetin
  • Lale Susan Türkgeldi
  • Gökçe Yılmaz
  • İbrahim Polat
  • Ali Gedikbaşı
Maternal-Fetal Medicine



We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single- or double-layered unlocked closure of their uterine incision during their first cesarean delivery.


This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section. Patients with a previous history of cesarean delivery, preterm pregnancies less than 34 gestational weeks, patients lost to follow-up or those who had an IUD inserted after delivery were excluded from the study. Out of the 327 patients who underwent primary cesarean delivery, 280 were included into the study. Patients were divided into two groups according to the single- (n:126) or double-layered (n:156) closure of their uterine incision. The maternal age, height, weight, obstetric and gynecologic histories, medical histories, indications for their cesarean delivery, technique of uterine closure, birth weight of the baby, duration of the cesarean delivery, need for extra suturing and transfusion were recorded. A Saline infusion sonography (SIS) was performed 3 months postoperatively to determine the presence, depth and length of the cesarean scar. The residual myometrial thickness overlying the scar defect and the fundal myometrial thickness were recorded.


No difference was detected between the groups with respect to patient characteristics, whether the operation was elective or emergent, the type of anesthesia used, need for extra suturing, incidence of bladder injuries or uterine atony, need for blood transfusions, duration of labour or cervical dilatation and effacement between the two groups. No statistically significant difference was detected between the two groups with respect to the length and depth of the scar defect.


Single- or double-layered closure of the uterus does not seem to affect the size of the uterine scar defect detected on SIS 3 months following the first cesarean delivery.


Cesarean delivery Uterine closure techniques Saline infusion sonography Uterine niche Scar defect 



NBT: Data collection, BAÇ: Manuscript writing, LST: Manuscript writing, GY: Data collection, IP: Project development, AG: Project development

Compliance with ethical standards

Conflict of interest


Ethical approval

All procedures performed were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Obstetrics and Gynecology Departmentİstanbul Beykoz State HospitalIstanbulTurkey
  2. 2.Department of Obstetrics and Gynecologyİstanbul Kanuni Sultan Süleyman Training and Research Hospital, AltınşehirİstanbulTurkey
  3. 3.Obstetrics and Gynecology DepartmentBolu İzzet Baysal State HospitalBoluTurkey

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