Short Term Comparison of Two Different Techniques of Uterine Cesarean Incision Closure

Not Applicable

Completed

Interventions: Procedure: Purse string closure technique
Procedure: Continuously locked closure technique

Brief Summary: Cesarean section (C/S) is an operation most commonly performed in Obstetrics and Gynecology Clinics. Complications related with incomplete healing of Kerr uterine incision after C/S (adhesions, separation (dehiscence), endometritis, endometriosis, anomalous placentation in subsequent pregnancies, incomplete or complete uterine rupture in subsequent pregnancies, ...) are very important issues. Classically Kerr incision is repaired with continuous locked suturing. Purse string suturing of Kerr incision may reduce the size of the incision and in turn may reduce short and long term complications. For this reason, the investigators aimed to compare two closure techniques.

Detailed Description: In the clinic, patients undergoing cesarean section that meet the criteria for inclusion into the study and agreed to participate in the study will be randomized into two groups (computer-assisted randomization method will be used.) In the first group of patients classical closure method of Kerr incision (double layered continuously locked suturing) will be used. In the second group of patients double layered purse string closure technique will be used. The two groups will be compared after 6 weeks in terms of healing, operation time, blood loss, incision size and incisional scar defect( if present). A physician who does not know the method of closure will evaluate incision size by transabdominal and/or transvaginal ultrasound. The length of the incision and myometrial thickness in Kerr incisional line will be measured and recorded in longitudinal and transverse axis separately. If any incisional scar defect is determined it will be measured and recorded also.

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

Being in active phase of labor
Emergency situations (fetal distress, cord prolapse, placental abruption,severe pre-eclampsia, eclampsia, placenta previa, vasa previa )
Having a history of uterine surgery (myomectomy, hysterotomy)other than C/S
Extension of Kerr incision
Multiple pregnancy
Maternal diabetes mellitus
Maternal connective tissue disease
Uterine malformation
Uterine fibroids on Kerr incision line
Chorioamnionitis

Arm && Interventions

Group	Intervention	Description
Purse string closure technique	Purse string closure technique	Eighty four patients were allocated to the study group. Due to expanded Kerr incisions 4 patients in study group did not receive their allocated intervention. In addition, 29 patients in the study group were lost to follow up and did not come to the sixth week check up. Statistical analysis is based on data from the remaining 51 study group.
Continuously locked closure technique	Continuously locked closure technique	Eighty four patients were allocated to the control group. Due to expanded Kerr incisions 3 patients in control group did not receive their allocated intervention. In addition, 16 patients in the control group were lost to follow up and did not come to the sixth week check up. Statistical analysis is based on data from the remaining 65 study group.

Primary Outcome Measures

Name	Time	Method
Cesarean Scar Defect in the Uterine Incisional Line	6 weeks after C/S	A wedge-shaped distortion in the integrity of the uterine incision scar during transvaginal ultrasonographic examination at 6 weeks after C/S was accepted as cesarean scar defect in the uterine incisional line and recorded as primary outcome measure, and two groups will be compared.

Secondary Outcome Measures

Name	Time	Method
Length of Uterine Incision After Suturing	6 weeks after C/S	Length of uterine incision after suturing will be examined and measured by ultrasonography, and two groups will be compared.