THE RISING prevalence of Caesarean deliveries has caused concerns about long-term complications, notably niche formation within the uterine scar. Amidst debates over uterine closure techniques, a recent study from the Netherlands aimed to shed light on the optimal approach.
The multicentre, double-blind, randomised controlled trial, known as the 2Close study, involved 32 hospitals, and over 2,000 females undergoing their first Caesarean delivery in the Netherlands, between 2016–2018. Participants were randomly assigned to receive either single layer or double layer closure of the uterine incision. The study evaluated outcomes over a 3-year follow-up period.
Results from the study presented a surprising finding. Despite the common belief favouring double layer closure, researchers found no significant difference in future live birth rates between the two closure techniques. Additionally, there were no disparities in pregnancy rates, the need for fertility treatments, mode of delivery, or uterine ruptures in subsequent pregnancies. However, the study did note a concerning trend of gynaecologic symptoms among participants, regardless of closure technique. Cases of spotting, dysmenorrhoea, and sexual dysfunction were reported in both groups, suggesting a high risk of post-Caesarean gynaecologic complications.
These findings challenge the current recommendation advocating for double layer closure, indicating that surgeons may opt for their preferred technique without compromising reproductive outcomes. The study highlights the importance of discussing the potential for gynaecologic symptoms with patients undergoing Caesarean deliveries.
With Caesarean deliveries becoming increasingly common worldwide, understanding the long-term implications of uterine closure techniques is crucial for maternal health. As researchers continue to investigate optimal practices, healthcare providers must prioritise informed discussions with patients, regarding potential risks and outcomes associated with Caesarean deliveries.
