Impact of Single- Versus Double-layer Hysterotomy Closure on Cesarean Niche Development: a Randomized Controlled Trial

Last updated: March 6, 2024
Sponsor: Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico
Overall Status: Active - Recruiting

Phase

N/A

Condition

Uterine Disorders

Treatment

Hysterotomy closure

Clinical Study ID

NCT06308172
CSI/2021
  • Ages > 18
  • Female

Study Summary

The objective of this randomized monocentric study is to assess potential variations in the incidence and severity of isthmocele morbidity among women undergoing cesarean section with either single or double-layer closure of the hysterotomy. Our primary outcome aims to investigate whether there is a reduction in the median duration of intermenstrual spotting in patients belonging to the two respective closure groups

Eligibility Criteria

Inclusion

Inclusion Criteria:

  • nulliparous
  • singleton
  • age 18-45
  • spontaneous pregnancy or autologous assisted fertilization
  • gestational age 38-40 weeks
  • elective C-section
  • informed consent

Exclusion

Exclusion Criteria:

  • coagulopathy
  • autoimmune diseases
  • gestational diabetes
  • anticoagulant therapy
  • immunosuppressive therapy
  • endometriosis
  • uterine fibromatosis
  • spontaneous labour
  • connective tissue diseases

Study Design

Total Participants: 150
Treatment Group(s): 1
Primary Treatment: Hysterotomy closure
Phase:
Study Start date:
December 01, 2021
Estimated Completion Date:
December 01, 2026

Study Description

Cesarean section, the most widely performed surgical procedure globally, has seen a significant increase in rates over the past decades, rising from 12.1% in 2000 to 21% in 2015 for various reasons. A recognized complication of cesarean sections is the formation of a uterine niche, commonly referred to as isthmocele. However, the true incidence of this post-operative complication remains uncertain, with reported figures ranging widely from 7% to 80%. The considerable variability in these estimates is attributed in part to the varying sensitivity of diagnostic tools. Moreover, there is a lack of consensus in the literature regarding the definition of a cesarean niche, particularly concerning the dimensions of the defect.

Recent well-designed randomized controlled trials have investigated the long-term outcomes of single versus double-layer hysterotomy closure during C-sections. These studies found no significant differences in isthmocele incidence or intermenstrual spotting. However, limitations such as the lack of correlation between symptom severity and uterine defect dimensions, the inclusion of women in labor, and relatively short follow-up periods are acknowledged weaknesses, prompting the need for further analysis.

Our objective is to compare the outcomes of single versus double-layer hysterotomy closure in terms of intermenstrual spotting and isthmocele incidence in singleton women undergoing elective C-sections. Crucially, standardizing the surgical suturing technique is essential to mitigate potential misleading outcomes resulting from inter-operator variations.

Connect with a study center

  • Fondazione Cà Granda IRCCS Ospedale Maggiore Policlinico di Milano

    Milan, Mi 20122
    Italy

    Active - Recruiting

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