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Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6\u00a0months after delivery. The secondary outcomes were incidence of scar defects at 6\u00a0weeks and 3\u00a0months.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD\u2009=\u2009\u2212 0.02 (\u2212 0.06, 0.02); <jats:italic>I<\/jats:italic>\n              <jats:sup>2<\/jats:sup>\u2009=\u200981%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01), and six months (RD\u2009=\u2009\u2212 0.11, CI \u2212 0.15, \u2212 0.07, I<jats:sup>2<\/jats:sup>\u2009=\u200991%, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Systematic review registration<\/jats:title>\n            <jats:p>PROSPERO, Unique identifier: CRD42024552495.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00404-025-08151-y","type":"journal-article","created":{"date-parts":[[2025,8,20]],"date-time":"2025-08-20T03:44:59Z","timestamp":1755661499000},"page":"1095-1106","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche: a systematic review and meta-analysis of randomized trials"],"prefix":"10.1007","volume":"312","author":[{"given":"Mattia","family":"Dominoni","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Torella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossella","family":"Molitierno","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario","family":"Fordellone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Saccone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dario","family":"Colacurci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio Simone","family":"Lagan\u00e0","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina Rita","family":"Pano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Barbara","family":"Gardella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"La Verde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,8,20]]},"reference":[{"issue":"1","key":"8151_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1515\/jpm-2020-0463","volume":"49","author":"S Nagy","year":"2020","unstructured":"Nagy S, Papp Z (2020) Global approach of the cesarean section rates. 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