DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20182319

Comparison of two different techniques of uterine closure in caesarean section: Continuous single layer technique versus Babu and Magon technique

S. Vinayachandran, Vedhapriya Sudhakar

Abstract


Background: To compare size of the caesarean scar and residual myometrial thickness (RMT) between continuous single non-interlocking and Babu and Magon technique for uterine closure following primary elective caesarean section (CS).

Methods: An observational prospective cohort study was conducted at 6 weeks and 4 months postpartum following primary elective CS. Group A included 25 patients who underwent continuous single layer technique and Group B included 25 patients who underwent Babu and Magon technique for uterine closure. Baseline demographic profile, obstetric score, details of the CS and associated complications were studied. Two-dimensional Transvaginal ultrasonography (TVS) measurements of the length, width and depth of the caesarean scar and RMT were compared.

Results: Mean age of study population was 29.6 years. Malpresentation (44%) was the most common indication for CS. Mean Bishops score at the time of CS was <4. The duration of surgery (-2.8 min, 37.96 ±5.660min) and estimated amount of blood loss (-51.6 ml, mean 671.20 ±136.208ml) was less in Group A compared to Group B (40.76 ±4.68min, 722.80±132.083ml respectively). The caesarean scar measurements were similar in both groups at both visits. The mean RMT in Group B at 6 weeks and 4 months postpartum (8.05mm±2.06 and 7.10mm±2.04 respectively) was statistically higher than Group A (6.23mm ± 1.76 and 5.36mm ± 1.70 respectively), p=0.002.

Conclusions: We conclude that Babu and Magon technique for uterine closure in caesarean section could result in better healing of the scar and probably reduce the adverse outcomes in subsequent pregnancies.


Keywords


Caesarean section, Residual myometrial thickness, Scar, Transvaginal ultrasound, Uterine closure

Full Text:

PDF

References


Hofmeyr GJ, Mathai M, Shah A, Novikova N. Techniques for caesarean section. Cochrane Database Syst Rev. 2008;1:CD004662.

Babu K, Magon N. Uterine closure in cesarean delivery: a new technique. N Am J Med Sci. 2012;4:358-61.

Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Ultrasound evaluation of Cesarean scar after single- and double-layer uterotomy closure: a cohort study. Ultrasound Obstet Gynecol. 2013;42:207-12.

Dodd JM, Anderson ER, Gates S, Grivell RM. Surgical techniques for uterine incision and uterine closure at the time of caesarean section. Cochrane Database Syst Rev. 2014:CD004732.

Hegde CV. The never-ending debate single-layer versus double-layer closure of the uterine incision at cesarean section. J Obstet Gynaecol India. 2014;64:239-40.

Jelsema RD, Wittingen JA, Vander Kolk KJ. Continuous, nonlocking, single-layer repair of the low transverse uterine incision. J Reprod Med. 1993;38:393-6.

Pomorski M, Fuchs T, Zimmer M. Prediction of uterine dehiscence using ultrasonographic parameters of cesarean section scar in the nonpregnant uterus: a prospective observational study. BMC Pregnancy Childbirth. 2014;14:365.

Naji O, Abdallah Y, Bij De Vaate AJ, Smith A, Pexsters A, Stalder C, et al. Standardized approach for imaging and measuring Cesarean section scars using ultrasonography. Ultrasound Obstet Gynecol. 2012;39:252-9.

Osser OV, Valentin L. Clinical importance of appearance of cesarean hysterotomy scar at transvaginal ultrasonography in nonpregnant women. Obstet Gynecol. 2011;117:525-32.

Osser OV, Jokubkiene L, Valentin L. High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination. Ultrasound Obstet Gynecol. 2009;34:90-7.

Roberge S, Demers S, Girard M, Vikhareva O, Markey S, Chaillet N, et al. Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial. Am J Obstet Gynecol. 2016;507:e1- e6.

Sevket O, Ates S, Molla T, Ozkal F, Uysal O, Dansuk R. Hydrosonographic assessment of the effects of 2 different suturing techniques on healing of the uterine scar after cesarean delivery. Int J Gynaecol Obstet. 2014;125:219-22.

Roberge S, Boutin A, Chaillet N, Moore L, Jastrow N, Demers S, et al. Systematic review of cesarean scar assessment in the nonpregnant state: imaging techniques and uterine scar defect. Am J Perinatol. 2012;29:465-71.