Surgery Techniques
Six operators performed the CD operations. Access to the abdomen was
achieved via Pfannenstiel incision, while the Kerr incision technique
was applied to the uterus for all patients. Patients in the single-layer
group received uterus closures with locking, while patients in the
double-layer group received uterus closures with locking in the first
layer, but without locking and using a parallel Lembert-type imbricating
stitch in the second layer. The decidua was deliberately excluded during
all suturations. A synthetic absorbable suture material (Vicryl 1.0,
Ethicon, Somerville, NJ, USA) was used during all uterus closures, with
corner stitches applied to all patients. Additional suture usages and
numbers were reported only in cases of bleeding. Both uterine closure
and whole operation times were recorded by the respective operating room
technicians. Finally, intravenous prophylactic antibiotics (2 g
cefazolin sodium) and uterotonic medications (10 IU oxytocin) were
routinely applied during all CD procedures.