RESULTS
A total of 282 patients met the initial inclusion criteria for this
study. Of these, 57 were excluded (20.2%); 49 were lost to follow-up
(17.4%), six became pregnant (2.1%), and two could not endure
ultrasonography due to intolerances to pelvic examinations (0.71%).
Thus, 225 patients were fully evaluated. Niche assessment was evaluated
via SIS in 221 patients, while TV USG was used for four patients due to
the use of intrauterine devices or intolerance to SIS. Of the 225 total
remaining participants, 109 were placed into the single-layer treatment
group, while 116 were placed into the double-layer treatment group
(Figure 1). Further, 165 (73.3%) patients reported that menstruation
had begun when they returned for checkups 6-9 months after CS.
Participants of both treatment groups were compared based on their
maternal and obstetric characteristics as well as those related to CD
operations. Except for shorter uterine closures and operation durations
for single-layer closures, all factors were similar between groups
(Table 1).
The CD indications were fetal presentation anomalies (n=36, 16%), fetal
distress (n=25, 11.1%), discontinued labor (n=31, 13.8%), maternal
request (n=57, 25.3%), cephalo-pelvic disproportion (n=47, 20.9%), and
reasons such as severe preeclampsia, maternal factors, fetal anomalies,
and placenta anomalies (n=29, 12.9%).
This study found that niche rates and mean depths for the TV USG and SIS
patients were 21%, 0.9±1.8mm and 41%, 2.1±1.9mm, respectively
(p<0.001, p<0.001). Niche positivity was determined
for 93 patients, while more frequent PMB and dysmenorrhea were observed
among patients for whom niches were determined (32.1% vs 5.2%;
p<0.001, 12.9% vs 4.6%; p=0.043). Niche shapes were
triangular (82%), oval (10.1%), circular (4.5%), square (2.2%), and
totally defective (%1.1), while niche rates were 37% for the
single-layer group and 45.7% for the double-layer group (p=0.22). No
significant differences were found between the niche depth measurements
used to define niche presence (p=0.10), nor were any significant
differences found in niche width measurements (p=0.07). However, niche
width was higher in the transvers plane among participants of the
double-layer group when compared to those in the single-layer group
(p=0.006) (Table 2). On the other hand, no significant intergroup
differences were found in terms of RMT, AMT, healing ratio values, and
PMB / dysmenorrhea symptoms (Table 2). Mean uterine closures and
operation durations were shorter among the single-layer group
(p<0.001, p=0.001).