Arch Gynecol Obstet. 2025 Aug 20. doi: 10.1007/s00404-025-08151-y. Online ahead of print.
ABSTRACT
OBJECTIVE: This systematic review and meta-analysis compared single- versus double-layer uterine closure at the time of cesarean delivery.
DATA SOURCES: MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception until May 2024.
STUDY ELIGIBILITY CRITERIA: We included only randomized controlled trials (RTSs) that compared single-layer versus double-layer uterine closure at the time of cesarean delivery.
STUDY APPRAISAL AND SYNTHESIS METHODS: Outcomes were analyzed using a random-effects model. Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6 months after delivery. The secondary outcomes were incidence of scar defects at 6 weeks and 3 months.
RESULTS: A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD = – 0.02 (- 0.06, 0.02); I2 = 81%, p < 0.01), and six months (RD = – 0.11, CI – 0.15, – 0.07, I2 = 91%, p < 0.01).
CONCLUSIONS: Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure.
SYSTEMATIC REVIEW REGISTRATION: PROSPERO, Unique identifier: CRD42024552495.
PMID:40833607 | DOI:10.1007/s00404-025-08151-y
