Closure of the uterine incision with one or two layers after caesarean section: a randomized controlled study in sheep

Abstract

Objective: To compare the quality of the uterine scar with one or two layer closure after caesarean section by studying biomechanical and pathological properties of the scar.

Methods: A randomized controlled trial performed on eight term pregnant ewes assigned into two groups during caesarean according to type of uterine closure: single-layer or double-layer. Hysterectomy was performed 8 months after caesarean delivery. Tensile strength of all scars and of unscarred myometrium was measured. Pathological properties of the scars were analyzed histologically.

Results: The force required to reach the yield point was similar between scarred and unscarred myometrium (p = 0.96), and between the scars in single-layer and double-layer closure groups (p = 0.65). There was a significant increase in fibrosis width on the superficial part of the uterus in the double-layer closure group compared to the single-layer group (p = 0.02).

Conclusions: Double-layer uterine closure modified wound healing without significant change in biomechanical properties.

• Caesarean section
• double-layer uterine closure
• sheep
• wound healing

Acknowledgements

We wish to thank Ms. Tania Fayad and Simon Blouin for critical review of the manuscript, Dr Jean-Paul Praud, Jean-Philippe Gagné, Robert Dumaine for organizational support and the Engineering Faculty of McGill University for technical support.

Notes

*Poster presentation at SMFM 28th Annual Meeting, The Pregnancy Meeting, Dallas, TX February 1, 2008 and Oral presentation at SOGC 64th Annual Clinical Meeting, Calgary, AB June 28, 2008.