Transvaginal ultrasound assessment of cesarean section uterine scar closed by single versus double-layer

Background Cesarean section (CS) is a widely performed procedure globally. The integrity of the uterine scar post-CS is critical in determining maternal outcomes in future pregnancies. Uterine closure technique is a modifiable factor that may influence scar healing. Objective To assess uterine scar healing following single versus double-layer closure techniques using transvaginal ultrasound (TVUS), focusing on niche formation and myometrial thickness. Patients and methods At Tanta University Hospitals, 60 women undergoing primary elective CS participated in a prospective observational study. Either the single-layer or double-layer uterine closure groups were assigned to participants at random. TVUS was used to evaluate scar integrity after 6 weeks, 3, and 6 months after surgery. Among the parameters were the healing ratio Residual Myometrial Thickness (RMT/Adjacent Myometrial Thickness), niche depth, and residual myometrial thickness (RMT). Results Niche formation was more frequent in the single-layer group (30%) than in the double-layer group (16.7%). The double-layer group also demonstrated significantly greater RMT and healing ratios. Although the single-layer technique reduced operative time, it was associated with inferior scar quality. Conclusion Double-layer uterine closure during CS is associated with better scar healing and less niche formation. TVUS is a reliable method for postoperative scar evaluation. Further studies are warranted to examine long-term reproductive outcomes.