Evaluation of the effect of different uterine closure techniques on the development of cesarean scar defect

The aim of this study was to comparatively evaluate the effects of different uterine closure techniques on the development of cesarean scar defect (CSD) in primary cesarean operations. Materials and Methods: In this prospective study, a total of 60 pregnant women with no previous cesarean history, at early term, term, and postterm gestational ages, were divided into two groups. In the control group, the classical single-layer locked uterine closure technique was used, while in the study group, a double-layer unlocked continuous closure technique with approximation of opposing wound edges parallel to the incision line was preferred. All patients were evaluated after the third postoperative month using trans vaginal ultrasonography (TVUSG), and saline infusion sonography (SIS) was performed in cases with no fluid observed in the cavity. Presence of CSD, defect depth and width, residual myometrial thickness (RMT), the distance between the uterine cavity and the defect, pre- and postoperative hemoglobin levels, and the presence of symptoms (abnormal uterine bleeding and pelvic pain) were recorded. Results:The incidence of cesarean scar defect was found to be significantly lower in the study group compared to the control group (p < 0.05). Furthermore, the depth and width of the defect were statistically lower in the study group. Residual myometrial thickness was significantly lower in the control group, indicating better myometrial healing in the study group. A statistically significant difference was found between symptom levels in the study group (p < 0.01), suggesting that the applied uterine closure technique may be effective in reducing symptom development. In the control group, a significant difference was found only between the presence and absence of symptoms, while no statistically significant difference was observed among specific symptom types. No significant difference was found between the groups regarding changes in postoperative hemoglobin levels. Conclusion:The double-layer unlocked uterine closure technique with approximation of opposing wound edges parallel to the incision is associated with lower cesarean scar defect incidence, greater residual myometrial thickness, and fewer symptoms compared to the classical single-layer locked technique. This technique may be considered an effective method to support uterine scar healing and reduce symptom development in primary cesarean surgeries.