{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:59:52Z","timestamp":1791835192415,"version":"4.3.4"},"reference-count":27,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2020,10,25]],"date-time":"2020-10-25T00:00:00Z","timestamp":1603584000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","award":["843002605"],"award-info":[{"award-number":["843002605"]}],"id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2021,4]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate whether double\u2010layer uterine closure after a first caesarean section (CS) is superior compared with single\u2010layer uterine closure in terms of postmenstrual spotting and niche development in the uterine caesarean scar.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Multicentre, double\u2010blind, randomised controlled superiority trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Thirty\u2010two hospitals in the Netherlands.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Population<\/jats:title>\n                    <jats:p>A total of 2292 women aged \u226518\u00a0years undergoing a first CS were randomly assigned to each procedure (1:1): 1144 women were assigned to single\u2010layer uterine closure and 1148 women were assigned to double\u2010layer uterine closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single\u2010layer unlocked closure and double\u2010layer unlocked closure, with the second layer imbricating the first.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Number of days with postmenstrual spotting during one menstrual cycle 9\u00a0months after CS. Secondary outcomes: perioperative and menstrual characteristics; transvaginal ultrasound measurements.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 774 (67.7%) women from the single\u2010layer group and 770 (67.1%) women from the double\u2010layer group were evaluable for the primary outcome, as a result of drop\u2010out and amenorrhoea. The mean number of postmenstrual spotting days was 1.33 (bootstrapped 95%\u00a0CI 1.12\u20131.54) after single\u2010layer closure and 1.26 (bootstrapped 95%\u00a0CI 1.07\u20131.45) after double\u2010layer closure (adjusted mean difference \u22120.07, 95%\u00a0CI \u22120.37 to 0.22,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.810). The operative time was 3.9\u00a0minutes longer (95%\u00a0CI 3.0\u20134.9\u00a0minutes,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0&lt;\u00a00.001) and niche prevalence was 4.7% higher (95%\u00a0CI 0.7\u20138.7%,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.022) after double\u2010layer closure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The superiority of double\u2010layer closure compared with single\u2010layer closure in terms of postmenstrual spotting after a first CS was not shown. Long\u2010term obstetric follow\u2010up of our trial is needed to assess whether uterine caesarean closure guidelines should be adapted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Tweetable abstract<\/jats:title>\n                    <jats:p>Double\u2010layer uterine closure is not superior for postmenstrual spotting after a first caesarean; single\u2010layer closure performs slightly better on other outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1471-0528.16472","type":"journal-article","created":{"date-parts":[[2020,9,6]],"date-time":"2020-09-06T02:34:40Z","timestamp":1599359680000},"page":"866-878","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":59,"title":["Effect of single\u2010 versus double\u2010layer uterine closure during caesarean section on postmenstrual spotting (2Close): multicentre, double\u2010blind, randomised controlled superiority trial"],"prefix":"10.1111","volume":"128","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1353-5576","authenticated-orcid":false,"given":"SI","family":"Stegwee","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amsterdam Reproduction &amp; 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Development Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3277-2542","authenticated-orcid":false,"given":"CJM","family":"de Groot","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amsterdam Reproduction &amp; Development Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"},{"name":"Department of Obstetrics and Gynaecology Amsterdam Reproduction &amp; Development Amsterdam UMC Universiteit van Amsterdam Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8248-2677","authenticated-orcid":false,"given":"JAF","family":"Huirne","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynaecology Amsterdam Reproduction &amp; Development Amsterdam UMC Vrije Universiteit Amsterdam Amsterdam the Netherlands"},{"name":"Department of Obstetrics and Gynaecology Amsterdam Reproduction &amp; 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