Double-layered purse string uterine suture employing the French
ambulatory cesarean section technique compared with single-layer
continuous uterine suture: An ultrasound evaluation randomized trial.
Abstract
Objective: To test the hypothesis that compared to single layer
continuous uterine suture (SLCUS), a double layered purse string uterine
suture (PSUS) significantly reduces cesarean scar defect (CSD) rates,
without increasing the perioperative maternal morbidity. Design :
Interventional prospective, randomized study . Setting: University
obstetric units in Tunisia. Population: 100 pregnant women with an
indication of a planned Caesarean. Methods: Patients were enrolled in 2
groups according to the uterine suture technique: SLCUS or PSUS. A
Saline infusion hysterosonography was performed by the same senior
obstetrician blinded to the uterine suture technique 6 months after
surgery . Main Outcome measures: Operative time and Calculated blood
loss (CBL) were used for the short time analysis . Uterine and CSD
measurements were used for the mid time analysis . Results : Despite a
few minutes longer operative time in SUS group (7.17 ± 2.31 min Vs. 6.31
± 3.04 min, p = 0.028 in SLCUS group; p <10‾³); there was no
significant difference in terms of CBL (520 ± 58 in SUS group vs. 536 ±
50 ml in SLCUS group, p = 0.724). The medium-term analysis showed a
significant decrease in the rate of CSD with the PSUS: 6.66% vs.40%
with SLUCS; p = 0.002. Moreover, SLUCS was the leading risk factor for
CSD : adjusted OR=6 ;95% CI [0- 1],p < 10‾³) . Conclusion
: Compared to single layer continuous suture, purse string uterine
suture significantly reduces cesarean scar defect rates, without
increasing the perioperative maternal morbidity. NCT03930134.
https://clinicaltrials.gov/ct2/show/NCT03930134