{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T18:16:18Z","timestamp":1793729778570,"version":"4.6.1"},"reference-count":44,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2018,1,30]],"date-time":"2018-01-30T00:00:00Z","timestamp":1517270400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Caesarean section (<jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content>) rates are rising globally. Long\u2010term adverse outcomes after <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> might be reduced when the optimal uterine closure technique becomes evident.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To determine the effect of uterine closure techniques after <jats:styled-content style=\"fixed-case\">CS<\/jats:styled-content> on maternal and ultrasound outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Search strategy<\/jats:title><jats:p>Literature search in electronic databases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Selection criteria<\/jats:title><jats:p>Randomised controlled trials (<jats:styled-content style=\"fixed-case\">RCT<\/jats:styled-content>s) or prospective cohort studies that evaluated uterine closure techniques and reported on ultrasound findings, perioperative or long\u2010term outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data collection and analysis<\/jats:title><jats:p>Twenty studies (15 053 women) were included in our meta\u2010analyses for various outcomes. We calculated pooled risk ratios (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>) and weighted mean differences (WMD) with 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> through random\u2010effect analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main results<\/jats:title><jats:p>Residual myometrium thickness (<jats:styled-content style=\"fixed-case\">RMT<\/jats:styled-content>), reported in eight studies (508 women), decreased by 1.26 mm after single\u2010 compared with double\u2010layer closure (95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22121.93 to \u22120.58), particularly when locked sutures were used. Healing ratio [<jats:styled-content style=\"fixed-case\">RMT<\/jats:styled-content>\/adjacent myometrium thickness (<jats:styled-content style=\"fixed-case\">AMT<\/jats:styled-content>)] decreased after single\u2010layer closure (<jats:styled-content style=\"fixed-case\">WMD<\/jats:styled-content> \u22127.74%, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u221213.31 to \u22122.17), particularly in the case of locked sutures. Niche prevalence increased (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.71, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.11\u20132.62) when the decidua was excluded. Dysmenorrhea occurred more often in the single\u2010layer group (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.23, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 1.01\u20131.48), whereas incidence of uterine rupture was similar (<jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content> 1.91, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.63\u20135.74).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Double\u2010layer unlocked sutures are preferable to single\u2010layer locked sutures regarding <jats:styled-content style=\"fixed-case\">RMT<\/jats:styled-content>, healing ratio and dysmenorrhoea. Excluding the decidua seems to result in higher niche prevalence. As thin residual myometrium or niches may serve as intermediates for gynaecological and reproductive outcomes, future studies should focus on these outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Tweetable abstract<\/jats:title><jats:p>#Uterineclosuretechniques after #caesarean affect #longtermoutcomes.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.15048","type":"journal-article","created":{"date-parts":[[2017,12,7]],"date-time":"2017-12-07T13:46:57Z","timestamp":1512654417000},"page":"1097-1108","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":90,"title":["Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"125","author":[{"given":"SI","family":"Stegwee","sequence":"first","affiliation":[{"name":"VU University Medical Centre Department of Obstetrics and Gynaecology Research Institutes \u2018ICaR\u2010VU\u2019 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