Comparing Decidual Inclusion vs. Exclusion in Uterine Suture Techniques During Cesarean Section to Improve Scar Thickness and Reduce Isthmocele Risk in Primiparous Women (DISSUC)
The Impact of Decidual Inclusion or Sparing in a Single Unlocked Closure of a Cesarean Uterine Incision: Randomized Controlled Trial
This study compares two ways of closing the uterus during cesarean delivery. In one group, the decidual layer near the uterine cavity is included in the suture. In the other group, this layer is left out. The study will examine whether these two methods differ in how well the uterine scar heals 6 to 9 months after surgery.
Women having an elective cesarean delivery will be randomly assigned to one of the two closure methods. Scar healing will be assessed by ultrasound after delivery. The goal is to determine whether one method is associated with better cesarean scar healing and fewer scar defects.
Studieöversikt
Status
Betingelser
Detaljerad beskrivning
Cesarean scar defects, also referred to as niches or isthmoceles, are associated with gynecologic symptoms and adverse outcomes in subsequent pregnancies. The effect of uterine closure technique on scar healing remains uncertain, particularly with regard to whether the cavum-near decidual layer should be included in or excluded from the suture during cesarean closure.
This study is a prospective, randomized, controlled trial comparing two approaches to single-layer, non-locked uterine closure during elective cesarean delivery: decidual inclusion and decidual sparing. In both study groups, all operative steps are standardized except for the handling of the cavum-near decidual layer at the uterotomy margin.
Participants will be followed 6 to 9 months after cesarean delivery, including blinded ultrasound assessment of cesarean scar healing. The objective is to determine whether decidual inclusion or decidual sparing is associated with differences in postoperative uterine scar healing and cesarean scar defect formation.
Studietyp
Inskrivning (Beräknad)
Fas
- Inte tillämpbar
Kontakter och platser
Studiekontakt
- Namn: Amr S. Hamza, Assoc. Prof.
- Telefonnummer: +41564863513
- E-post: amr.hamza@ksb.ch
Studera Kontakt Backup
- Namn: Leonhard Schaeffer, Prof.
- Telefonnummer: +41564863506
- E-post: leonhard.schaeffer@ksb.ch
Studieorter
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Canton of Aargau
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Baden, Canton of Aargau, Schweiz, 5400
- Rekrytering
- Kantonsspital Baden
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Kontakt:
- Amr S. Hamza, Assoc. Prof.
- Telefonnummer: +41564863513
- E-post: amr.hamza@ksb.ch
-
Kontakt:
- Leonhard Schaeffer, Prof.
- Telefonnummer: +41564863506
- E-post: leonhard.schaeffer@ksb.ch
-
-
Deltagandekriterier
Urvalskriterier
Åldrar som är berättigade till studier
- Vuxen
- Äldre vuxen
Tar emot friska volontärer
Beskrivning
Inclusion Criteria:
- Singleton, term pregnancy
- Elective cesarean section before labor onset or membrane rupture
- Maternal age >18 years
- Ability to provide informed consent
Exclusion Criteria:
- Placenta previa
- Maternal substance abuse or infection
- Suspected placenta accreta
- Diabetes
- one or more prior cesarean section
- Vulnerable participants (e.g., mental health conditions)
- Emergency cesarean sections
Studieplan
Hur är studien utformad?
Designdetaljer
- Primärt syfte: Förebyggande
- Tilldelning: Randomiserad
- Interventionsmodell: Parallellt uppdrag
- Maskning: Dubbel
Vapen och interventioner
Deltagargrupp / Arm |
Intervention / Behandling |
|---|---|
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Experimentell: Decidual Inclusion Closure
Participants randomized to this arm will undergo elective cesarean delivery with single-layer, non-locked uterine closure in which the cavum-near decidual layer at the uterotomy margin is included in the suture.
All other operative steps will be performed according to the standardized study protocol.
|
During the cesarean section, the uterine incision is closed with a single-layered, non-locked suture. In this technique, the decidua (the uterine lining) is included in the closure. This means that the endometrial cells are part of the suture, potentially influencing the healing process of the uterine scar. Goal: The idea is that including the decidua may promote better healing and scar formation, reducing the risk of complications such as isthmocele and improving long-term uterine health. |
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Experimentell: Decidual Sparing Closure
Participants randomized to this arm will undergo elective cesarean delivery with single-layer, non-locked uterine closure in which the cavum-near decidual layer at the uterotomy margin is excluded from the suture.
All other operative steps will be performed according to the standardized study protocol.
|
Procedure: In this technique, the uterine incision is also closed using a single-layered non-locked suture, but the decidua is excluded from the closure. The suture is placed only through the myometrium (muscle layer) of the uterus, leaving the decidua out of the scar tissue. Goal: The intent is to observe if sparing the decidua results in better scar healing and a lower risk of isthmocele formation, as well as fewer long-term complications. |
Vad mäter studien?
Primära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Proportion of participants with a cesarean scar niche measured by ultrasound
Tidsram: 6 to 9 months post-operation
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Presence of a cesarean scar niche, defined as a myometrial indentation at the cesarean scar site with a depth of at least 2 mm, assessed by postoperative ultrasound.
The outcome will be reported as the proportion of participants with a niche in each treatment group.
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6 to 9 months post-operation
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Sekundära resultatmått
Resultatmått |
Åtgärdsbeskrivning |
Tidsram |
|---|---|---|
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Residual-to-adjacent myometrial thickness ratio
Tidsram: 6 to 9 months post-operation
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Ratio of residual myometrial thickness to adjacent myometrial thickness measured by ultrasound.
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6 to 9 months post-operation
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Operative time
Tidsram: Periprocedural
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Operative time in minutes
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Periprocedural
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Need for additional sutures for hemostasis
Tidsram: Periprocedural
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Need for additional hemostatic sutures, yes (how many: __ Number) /no
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Periprocedural
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Length of hospital stay
Tidsram: Postoperative day 2
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Length of postoperative hospital stay in days
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Postoperative day 2
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Postoperative pain intensity on the 11-point Numeric Rating Scale
Tidsram: Postoperative day 2
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Pain intensity assessed using an 11-point Numeric Rating Scale ranging from 0 to 10, where 0 indicates no pain and 10 indicates the worst imaginable pain.
Higher scores indicate worse pain.
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Postoperative day 2
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Postoperative bleeding
Tidsram: Postoperative day 2
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Clinically relevant postoperative bleeding, yes/no
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Postoperative day 2
|
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Wound infection
Tidsram: Postoperative day 2
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Postoperative wound infection, yes/no
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Postoperative day 2
|
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Postoperative fever
Tidsram: Postoperative day 2
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Postoperative fever, yes/no
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Postoperative day 2
|
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Abnormal uterine bleeding
Tidsram: 6 to 9 months post-operation
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Abnormal uterine bleeding reported at follow-up, yes/no
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6 to 9 months post-operation
|
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Dysmenorrhea
Tidsram: 6 to 9 months post-operation
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Dysmenorrhea reported at follow-up, yes/no
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6 to 9 months post-operation
|
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Chronic pelvic pain
Tidsram: 6 to 9 months post-operation
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Chronic pelvic pain reported at follow-up, yes/no
|
6 to 9 months post-operation
|
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Dyspareunia
Tidsram: 6 to 9 months post-operation
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Dyspareunia reported at follow-up, yes/no
|
6 to 9 months post-operation
|
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Cesarean scar niche length measured by ultrasound in mm
Tidsram: 6 to 9 months post-operation
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Length of cesarean scar niche in mm measured by ultrasound.
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6 to 9 months post-operation
|
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Cesarean scar niche depth measured by ultrasound in mm
Tidsram: 6 to 9 months post-operation
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Depth of cesarean scar niche in mm measured by ultrasound.
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6 to 9 months post-operation
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Cesarean scar niche width measured by ultrasound in mm
Tidsram: 6 to 9 months post-operation
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Width of cesarean scar niche in mm measured by ultrasound.
|
6 to 9 months post-operation
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Residual myometrial thickness measured by ultrasound in mm
Tidsram: 6 to 9 months post-operation
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Residual myometrial thickness measured by ultrasound in mm
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6 to 9 months post-operation
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Presence of intrauterine fluid on ultrasound
Tidsram: 6 to 9 months post-operation
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Presence or absence of intrauterine fluid on ultrasound.
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6 to 9 months post-operation
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Samarbetspartners och utredare
Sponsor
Utredare
- Huvudutredare: Amr S. Hamza, Assoc. Prof., Kantonsspital Baden
Studieavstämningsdatum
Studera stora datum
Studiestart (Faktisk)
Primärt slutförande (Beräknad)
Avslutad studie (Beräknad)
Studieregistreringsdatum
Först inskickad
Först inskickad som uppfyllde QC-kriterierna
Första postat (Faktisk)
Uppdateringar av studier
Senaste uppdatering publicerad (Faktisk)
Senaste inskickade uppdateringen som uppfyllde QC-kriterierna
Senast verifierad
Mer information
Termer relaterade till denna studie
Nyckelord
Ytterligare relevanta MeSH-villkor
- Urogenitala sjukdomar
- Genitala sjukdomar
- Mentala störningar
- Genitala sjukdomar, manliga
- Manliga urogenitala sjukdomar
- Kvinnliga urogenitala sjukdomar
- Kvinnliga urogenitala sjukdomar och graviditetskomplikationer
- Genitala sjukdomar, kvinnor
- Sexuell dysfunktion, fysiologisk
- Sexuella dysfunktioner, psykologiska
- Dyspareuni
Andra studie-ID-nummer
- StudyKSBHAM001
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