Single- Versus Double-Layer Uterine Closure After Cesarean Section Delivery: A Systematic Review and Meta-Analysis

Kaif Qayum, Irfan Kar, Junaid Sofi, Hari Panneerselvam, Kaif Qayum, Irfan Kar, Junaid Sofi, Hari Panneerselvam

Abstract

Cesarean section (CS) delivery is a common procedure, and its incidence is increasing globally. To compare single-layer (SL) with double-layer (DL) uterine closure techniques after cesarean section in terms of ultrasonographic findings and rate of CS complications. PubMed, Scopus, Web of Science, and Cochrane Library were searched for relevant randomized clinical trials (RCTs). Retrieved articles were screened, and relevant studies were included in a meta-analysis. Continuous data were pooled as mean difference (MD) with 95% confidence interval (CI), and dichotomous data were pooled as relative risk (RR) and 95% CI. Analysis was conducted using RevMan software (Version 5.4). Eighteen RCTs were included in our study. Pooled results favored DL uterine closure in terms of residual myometrial thickness (MD = -1.15; 95% CI -1.69, -0.60; P < 0.0001) and dysmenorrhea (RR = 1.36; 95% CI 1.02, 1.81; P = 0.04), while SL closure had shorter operation time than DL closure (MD = -2.25; 95% CI -3.29, -1.21; P < 0.00001). Both techniques had similar results in terms of uterine dehiscence or rupture (RR = 1.88; 95% CI 0.63, 5.62; P = 0.26), healing ratio (MD = -5.00; 95% CI -12.40, 2.39; P = 0.18), maternal infectious morbidity (RR = 0.94; 95% CI 0.66, 1.34; P = 0.72), hospital stay (MD = -0.12; 95% CI -0.30, 0.06; P = 0.18), and readmission rate (RR = 0.95; 95% CI 0.64, 1.40; P = 0.78). Double-layer uterine closure shows more residual myometrial thickness and lower incidence of dysmenorrhea than single-layer uterine closure of cesarean section scar. But single-layer closure has the advantage of the shorter operation time. Both methods have comparable blood loss amount, healing ratio, hospital stay duration, maternal infection risk, readmission rate, and uterine dehiscence or rupture risk.

Keywords: cesarean section; double-layer; residual myometrium thickness; single-layer; uterine closure.

Conflict of interest statement

The authors have declared that no competing interests exist.

Copyright © 2021, Qayum et al.

Figures

Figure 1. PRISMA flow chart summarizing the…
Figure 1. PRISMA flow chart summarizing the process of data collection and study selection.
PRISMA: Preferred Reporting Items for Systematic reviews and Meta-Analyses.
Figure 2. Risk of bias graph.
Figure 2. Risk of bias graph.
Figure 3. Risk of bias summary.
Figure 3. Risk of bias summary.
Figure 4. Forest plot comparing single- versus…
Figure 4. Forest plot comparing single- versus double-layer uterine closure in terms of residual myometrial thickness.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 5. Forest plot comparing single- versus…
Figure 5. Forest plot comparing single- versus double-layer uterine closure in terms of dysmenorrhea.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 6. Forest plot comparing single- versus…
Figure 6. Forest plot comparing single- versus double-layer uterine closure in terms of uterine dehiscence or rupture.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 7. Forest plot comparing single- versus…
Figure 7. Forest plot comparing single- versus double-layer uterine closure in terms of healing ratio.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 8. Forest plot comparing single- versus…
Figure 8. Forest plot comparing single- versus double-layer uterine closure in terms of blood loss.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 9. Forest plot comparing single- versus…
Figure 9. Forest plot comparing single- versus double-layer uterine closure in terms of operative time.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 10. Forest plot comparing single- versus…
Figure 10. Forest plot comparing single- versus double-layer uterine closure in terms of maternal infectious morbidity.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 11. Forest plot comparing single- versus…
Figure 11. Forest plot comparing single- versus double-layer uterine closure in terms of hospital stay.
SL, single-layer uterine closure; DL, double-layer uterine closure.
Figure 12. Forest plot comparing single- versus…
Figure 12. Forest plot comparing single- versus double-layer uterine closure in terms of readmission rate.
SL, single-layer uterine closure; DL, double-layer uterine closure.

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Source: PubMed

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