Compared to single-layer closure, double-layer closure may not exhibit superior reproductive outcomes after first cesarean delivery: Study

Key Findings:

• The study included 2292 women, with 830 in the single-layer closure group and 818 in the double-layer closure group.

• At the 3-year follow-up, there were no significant differences in live birth rates between the two closure techniques.

• Secondary outcomes, including pregnancy rate, need for fertility treatments, mode of delivery, and obstetrical complications, also showed no significant differences between the groups.

• Both groups reported high rates of gynecologic symptoms, including spotting, dysmenorrhea, and sexual dysfunction.

The study did not find superiority of double-layer closure over single-layer closure in terms of reproductive outcomes after a first cesarean delivery. This challenges the current recommendation favoring double-layer closure, suggesting that surgeons can choose their preferred technique. Additionally, the high prevalence of gynecologic symptoms after cesarean delivery highlights the importance of discussing these risks with patients.

Surgeons should consider individual patient factors and preferences when choosing uterine closure techniques during cesarean deliveries. Patient counseling regarding the potential for gynecologic symptoms post-delivery is crucial for informed decision-making. Further research may be needed to elucidate the long-term effects of different closure methods on maternal health and reproductive outcomes.

Reference:

Verberkt, C., Stegwee, S. I., Van der Voet, L. F., Van Baal, W. M., Kapiteijn, K., Geomini, P. M. A. J., Van Eekelen, R., de Groot, C. J. M., de Leeuw, R. A., Huirne, J. A. F., van Baal, M., Klerkx, W., Bekker, M. N., de Boer, K., Boormans, E. M. A., van Eijndhoven, H. W. F., Feitsma, H., Hehenkamp, W. J. K., Hemelaar, M., … de Vleeschouwer, M. Single-layer vs double-layer uterine closure during cesarean delivery: 3-year follow-up of a randomized controlled trial (2Close study). American Journal of Obstetrics and Gynecology,2023. https://doi.org/10.1016/j.ajog.2023.12.032