{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:51:23Z","timestamp":1791881483761,"version":"4.3.4"},"reference-count":25,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:00:00Z","timestamp":1788566400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T00:00:00Z","timestamp":1788566400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Ultrasound Medicine"],"published-print":{"date-parts":[[2026,11]]},"abstract":"\n Objectives<\/jats:title>\n To compare residual myometrial thickness and cesarean scar elastography findings following single\u2010 versus double\u2010layer uterine closure in women undergoing primary cesarean delivery.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this prospective comparative cohort study, 100 women undergoing primary cesarean delivery at Izmir City Hospital between November 2024 and February 2025 were included. Participants were allocated according to the operating surgeon's routine uterine closure technique into single\u2010layer (\n n<\/jats:italic>\n \u2009=\u200950) and double\u2010layer (\n n<\/jats:italic>\n \u2009=\u200950) groups. Maternal characteristics, perioperative outcomes, hemoglobin changes, postoperative pain scores, and the requirement for additional hemostatic sutures were recorded. At 6\u2009weeks postpartum, residual myometrial thickness, endometrial thickness, and cesarean scar elastography were assessed by ultrasonography. Exploratory receiver operating characteristic (ROC) analysis was performed to evaluate the discriminatory performance of the imaging parameters.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Baseline demographic and perioperative characteristics were comparable between groups. The single\u2010layer group required more additional intraoperative hemostatic sutures than the double\u2010layer group (\n p<\/jats:italic>\n \u2009=\u2009.002). Perioperative hemoglobin decline, postoperative pain scores, operative duration, and hospital stay did not differ significantly (all\n p<\/jats:italic>\n \u2009>\u2009.05). Residual myometrial thickness (5.7 versus 4.9\u2009mm,\n p<\/jats:italic>\n \u2009=\u2009.001), endometrial thickness (7.9 versus 6.4\u2009mm,\n p<\/jats:italic>\n \u2009=\u2009.042), and elastography scores (11.1 versus 8.2,\n p<\/jats:italic>\n \u2009<\u2009.001) were significantly greater following double\u2010layer closure. Elastography demonstrated the highest discriminatory performance in the exploratory ROC analysis (AUC\u2009=\u20090.827).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n Double\u2010layer uterine closure was associated with greater residual myometrial thickness, higher cesarean scar elastography scores, and a reduced need for additional hemostatic sutures than single\u2010layer closure. These findings indicate more favorable early postoperative scar characteristics; however, their clinical significance and implications for long\u2010term reproductive and obstetric outcomes remain uncertain.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/jum.70433","type":"journal-article","created":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T08:57:41Z","timestamp":1788598661000},"page":"2559-2567","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Residual Myometrial Thickness and Scar Elastography After Single\u2010 Versus Double\u2010Layer Uterine Closure Following Primary Cesarean Delivery"],"prefix":"10.1002","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-7115-7064","authenticated-orcid":false,"given":"G\u00f6k\u00e7e","family":"\u00dcnal","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology Izmir City Hospital Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1699-8667","authenticated-orcid":false,"given":"Ya\u015fam Kemal","family":"Akpak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Izmir City Hospital Izmir Turkey"},{"name":"Department of Obstetrics and Gynaecology Izmir Faculty of Medicine, University of Health Sciences Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1102-9741","authenticated-orcid":false,"given":"Eda","family":"G\u00fcner \u00d6zen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Izmir City Hospital Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1576-5324","authenticated-orcid":false,"given":"K\u00fcbra","family":"Adsaz Parlar","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Izmir City Hospital Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3230-2778","authenticated-orcid":false,"given":"Sezin","family":"\u00c7\u00f6mez","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Izmir City Hospital Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1473-0472","authenticated-orcid":false,"given":"Ahkam G\u00f6ksel","family":"Kanmaz","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology Izmir City Hospital Izmir Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,5]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2021-005671"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.13526"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13199"},{"key":"e_1_2_8_5_1","first-page":"2695","article-title":"Why do niches develop in caesarean uterine scars? Hypotheses on the aetiology of niche development","volume":"30","author":"Vervoort AJMW","year":"2015","journal-title":"Hum Reprod"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.15048"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2014.06.014"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13714"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1080\/08941939.2019.1610530"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340500430436"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12376"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00404-018-4702-z"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.7150\/thno.18650"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0043-119412"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.18565\/aig.2016.11.22-27"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinimag.2020.03.006"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2018.04.013"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/hsr2.1274"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17401"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13213"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diii.2013.01.022"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ultrasmedbio.2015.03.009"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12212166"},{"key":"e_1_2_8_24_1","article-title":"Single\u2010versus double\u2010layer uterine closure after cesarean section delivery: a systematic review and meta\u2010analysis","volume":"13","author":"Qayum K","year":"2021","journal-title":"Cureus"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijgo.2011.04.013"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/aogs.13585"}],"container-title":["Journal of Ultrasound in Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jum.70433","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/jum.70433","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/jum.70433","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T08:25:46Z","timestamp":1791879946000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/jum.70433"}},"subtitle":["A Prospective Cohort Study"],"short-title":[],"issued":{"date-parts":[[2026,9,5]]},"references-count":25,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2026,11]]}},"alternative-id":["10.1002\/jum.70433"],"URL":"https:\/\/doi.org\/10.1002\/jum.70433","archive":["Portico"],"relation":{},"ISSN":["0278-4297","1550-9613"],"issn-type":[{"value":"0278-4297","type":"print"},{"value":"1550-9613","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,5]]},"assertion":[{"value":"2026-07-12","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-17","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-05","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}