Three-Layer Anatomical Uterine Closure Versus Conventional Two-Layer Closure for Early Cesarean Scar Sonographic Morphology: A Randomized Controlled Trial

Objective

To compare early cesarean scar morphology between three-layer anatomical uterine closure and conventional two-layer closure, using the residual-to-adjacent myometrial thickness ratio (RMT/AMT) at 6 weeks postpartum as the primary outcome. Materials and Methods: In this randomized controlled trial, 60 women undergoing primary cesarean delivery were assigned 1:1 to conventional two-layer or three-layer anatomical closure, with randomization stratified by elective or emergency cesarean delivery. Transvaginal ultrasound was performed at 6 weeks postpartum by a blinded examiner. The primary outcome was the RMT/AMT ratio. Secondary outcomes included residual myometrial thickness, adjacent myometrial thickness, niche depth, niche length, niche depth/AMT ratio, niche presence, operative time, and estimated blood loss.