Kirtirekha Mohapatra1, Subhra Ghosh2, Pallabi Nayak3
There are few issues in modern obstetrics that have been as controversial as management of a woman with a prior caesarean delivery. Hence, it is required to have evidence based correct practice of this surgical procedure. Healing of the uterine incision and the strength of the scar should be the most important consideration. The aim of the study is to compare the effect of technique of uterine closure (Single Layer vs. Double Layer) on subsequent pregnancies and to find out, which technique has a better maternal and neonatal outcome by strengthening the scar.
MATERIALS AND METHODS
500 cases of previous caesarean section pregnancies were taken, 250 from single layer closure group and 250 from double layer closure group. The mode of delivery during present pregnancy was noted. Integrity of scar, thickness of scar, presence of adhesion were documented. The neonates were observed. Results were compared so as to draw an inference about the better method.
Mean age between the two groups were similar. Majority did not have history of premature rupture of membrane during previous pregnancy. Postoperative complications were more when double layer closure of uterine scar was done in index surgery. Interpregnancy gap of <3 years was more commonly present in double layer closure group (52.8% in double layer versus 34.8% in single layer). Single layer had more scar tenderness (21.2%), thinned out scars (34.6%), incomplete ruptures (7.1%) and complete ruptures (2.8%) than double layer closure group. Neonatal outcomes were not statistically different in both the groups.
Double layer uterine closure seems to have better impact on scar integrity as compared to single layer uterine closure.