{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T19:59:54Z","timestamp":1791835194549,"version":"4.3.4"},"reference-count":20,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,9,21]],"date-time":"2017-09-21T00:00:00Z","timestamp":1505952000000},"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":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Cesarean deliveries are the most common abdominal surgery procedure globally, and the optimal way to suture the hysterotomy remains a matter of debate. The aim of this study was to assess the incidence of cesarean scar niches and the depth after single\u2010 or double\u2010layer uterine closure.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>We performed a randomized controlled trial in which women were allocated to three uterotomy suture techniques: continuous single\u2010layer unlocked, continuous locked single\u2010layer, or double\u2010layer sutures. Transvaginal ultrasound was performed six weeks and 6\u201324 months after cesarean delivery [Clinicaltrials.gov (<jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>02338388)].<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study included 435 women. Six weeks after delivery, the incidence of niche was not significantly different between the groups (<jats:italic>p<\/jats:italic> = 0.52): 40% for single\u2010layer unlocked, 32% for single\u2010layer locked and 43% for double\u2010layer sutures. The mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> niche depths were 3.0 \u00b1 1.4 mm for single\u2010layer unlocked, 3.6 \u00b1 1.7 mm for single\u2010layer locked and 3.3 \u00b1 1.3 mm for double\u2010layer sutures (<jats:italic>p<\/jats:italic> = 1.0). There were no significant differences (<jats:italic>p<\/jats:italic> = 0.58) in niche incidence between the three groups at the second ultrasound follow up: 30% for single\u2010layer unlocked, 23% for single\u2010layer locked and 29% for double\u2010layer sutures. The mean \u00b1 <jats:styled-content style=\"fixed-case\">SD<\/jats:styled-content> niche depth was 3.1 \u00b1 1.5 mm after single\u2010layer unlocked, 2.8 \u00b1 1.5 mm after single\u2010layer locked and 2.5 \u00b1 1.2 mm after double\u2010layer sutures (<jats:italic>p<\/jats:italic> = 0.61). There was a trend (<jats:italic>p<\/jats:italic> = 0.06) for the residual myometrium thickness to be thicker after double\u2010layer repair at the long\u2010term follow up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The incidence of cesarean scar niche formation and the niche depth was independent of the hysterotomy closure technique.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.13213","type":"journal-article","created":{"date-parts":[[2017,8,21]],"date-time":"2017-08-21T09:32:35Z","timestamp":1503307955000},"page":"1484-1489","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single\u2010 or double\u2010layer uterotomy closure: a randomized controlled trial"],"prefix":"10.1111","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8135-0453","authenticated-orcid":false,"given":"Christian","family":"Bamberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics Charit\u00e9\u2010University Medical Center Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Larry","family":"Hinkson","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Charit\u00e9\u2010University Medical Center Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joachim W.","family":"Dudenhausen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Charit\u00e9\u2010University Medical Center Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verena","family":"Bujak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Charit\u00e9\u2010University Medical Center Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim D.","family":"Kalache","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Charit\u00e9\u2010University Medical Center Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wolfgang","family":"Henrich","sequence":"additional","affiliation":[{"name":"Department of Obstetrics Charit\u00e9\u2010University Medical Center Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,9,21]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s003300050103"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.10077"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1304829"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.1033"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.7863\/jum.2001.20.10.1105"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13199"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2010.02631.x"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6405"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/1471-0528.12542"},{"key":"e_1_2_7_11_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 AJ","year":"2015","journal-title":"Hum Reprod"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejogrb.2005.03.023"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0b013e318163c90b"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1055\/s\u20100042\u2010112223"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1600-0412.1999.780709.x"},{"key":"e_1_2_7_16_1","first-page":"245","article-title":"Evaluation during early puerperium of the low transverse incision after cesarean section through vaginal ultrasonography","volume":"30","author":"Koutsougeras G","year":"2003","journal-title":"Clin Exp Obstet Gynecol"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5200"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.8864"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/00016340500430436"},{"key":"e_1_2_7_20_1","first-page":"530","article-title":"Uterine closure with unlocked suture in cesarean section: safety and Quality","volume":"30","author":"Turan GA","year":"2014","journal-title":"Pak J Med Sci"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.17401"}],"container-title":["Acta Obstetricia et Gynecologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Faogs.13213","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aogs.13213","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,7]],"date-time":"2023-10-07T06:50:30Z","timestamp":1696661430000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1111\/aogs.13213"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,9,21]]},"references-count":20,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1111\/aogs.13213"],"URL":"https:\/\/doi.org\/10.1111\/aogs.13213","archive":["Portico"],"relation":{},"ISSN":["0001-6349","1600-0412"],"issn-type":[{"value":"0001-6349","type":"print"},{"value":"1600-0412","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,9,21]]},"assertion":[{"value":"2017-07-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-08-15","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-21","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}