Published: 2019-11-26

Modified mattress sutures vs running sutures in uterine closure: which is better?

Swar S. Shah, Jayneel V. Shah, Shivani A. Valia, Uday J. Patel


Background: Conventional closure of uterus has been known to bear risk of scar dehiscence and scar rupture in subsequent pregnancies and thus, a study was conducted to compare the outcome of uterine closure with modified mattress manner and running manner and to establish a better method of uterine closure during caesarean section. Objective was to compare the conventional single layer running sutures and single layer modified mattress sutures for closure of uterus in caesarean section and find out which method is superior.

Methods: This prospective interventional study was carried out in Dhiraj Hospital, a tertiary care hospital in Vadodara. 60 pregnant women in the study criteria were equally divided randomly into 2 groups. Uterine closure was done in single layered sutures, one by running sutures and other group by modified mattress sutures.

Results: Uterine scar thickness on 8th day and 6 months post-operatively was significantly more in single layered suturing by modified mattress suture compared to running suture (p <0.05).

Conclusions: Uterine closure by single layered modified mattress suture is better in comparison to conventional single layer running suture.


Caesarean section, Modified mattress suture, Running suture, Scar thickness, Suturing technique, Uterine closure

Full Text:



Todman D. A history of caesarean section: From ancient world to the modern era. Aust N Z J Obstet Gynaecol. 2007;47:357-61.

Boley JP. The history of caesarean section. CMAJ. 1991;145:319-22.

Garrigues HJ. The improved cesarean section. Am J Obstet. 1883;16:33.

Porro E. Della amputazione utero-ovarica come complemento di taglio cesareo. Ann Univ Med Chir (Milan). 1876;237:289-350.

Sanger M. Der Kaiserschnitt. Arch Gynak. 1882;19:370.

Tully L, Gates S, Brocklehurst P, McKenzie-McHarg K, Ayers S. Surgical techniques used during caesarean section operations: Results of a national survey of practice in the UK. Eur J Obstet Gynecol Reprod Biol. 2002;102:120-6.

Babu KM, Magon N. Uterine closure in cesarean delivery: A new technique. North Am J Med Sci. 2012;4(8):358.

Shrestha P, Shrestha S, Gyawali M. Ultrasound evaluation of uterine scar in primary caesarean section: a study of single versus double layer uterine closure. Am J Public Health Res. 2015;12:178-81.

Dandolu V, Raj J, Harmanli O, Lorico A, Chatwani AJ. Resident education regarding technical aspects of cesarean section. J Reprod Med. 2006;51:49-54.

Williams JW. A critical analysis of 21 years experience with cesarean section. Bull Johns Hopkins Hosp. 1921;32:173.

Schwarz O, Paddock R, Bortnic AR. The cesarean scar: An experimental study. Am J Obstet Gynecol. 1938;36:962.

Roberge S, Chaillet N, Boutin A, Moore L, Jastrow N, Brassard N, et al. Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet. 2011;115:5-10.

Gyamfi C, Juhasz G, Gyamfi P, Blumenfeld Y, Stone JL. Single-versus double-layer uterine incision closure and uterine rupture. J Maternal Fetal Neonatal Med. 2006;19(10):639-43.