{"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":1791835194551,"version":"4.3.4"},"reference-count":14,"publisher":"FapUNIFESP (SciELO)","issue":"3","license":[{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,1,1]],"date-time":"2025-01-01T00:00:00Z","timestamp":1735689600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Rev. Assoc. Med. Bras."],"abstract":"<jats:p>SUMMARY  OBJECTIVE: Isthmocele or cesarean scar defect is a pouch-like defect in the myometrium at the isthmic level that is thought that it might occur as a result of the insufficient healing process of the uterine incision after cesarean section. It is important not to underestimate isthmocele and its preventive measures since it might cause serious gynecologic and obstetric complications. However, the best suturing technique suitable for the prevention of isthmocele formation is yet to be identified. The aim of this study was to compare the effects of three different uterine closure techniques applied during cesarean section on isthmocele formation.  METHODS: In this prospective study, a total of 120 term (&gt;37 weeks) pregnant women with no history of cesarean section and scheduled for primary cesarean section were randomized preoperatively to three different uterotomy closure techniques (baseball, single-locked, and single-unlocked groups).  RESULTS: In a total of 43 patients, postoperative third-month sonography revealed isthmocele as an anechoic triangular area with \u22651 mm depth at the scar site. Compared with the single-locked and single-unlocked groups, isthmocele development was significantly lower in the baseball-type closure group (47.5% in the single-locked, 46.2% in the single-unlocked, and 15.4% in the baseball-type closure group). The group with the highest residual myometrial thickness, that is, 5.7 mm, was again the patients who underwent baseball sutures.  CONCLUSION: Uterotomy closure with baseball-type suturing seems to be an advantageous method as compared to the traditional techniques in terms of preserving the residual myometrial thickness and preventing isthmocele formation.<\/jats:p>","DOI":"10.1590\/1806-9282.20241507","type":"journal-article","created":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T11:06:59Z","timestamp":1746184019000},"source":"Crossref","is-referenced-by-count":3,"title":["Is cesarean scar defect becoming history? The effect of uterotomy closure"],"prefix":"10.1590","volume":"71","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4746-5414","authenticated-orcid":false,"given":"Neset","family":"Gumusburun","sequence":"first","affiliation":[{"name":"Tokat Gaziosmanpasa University Hospital,  T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6618-6528","authenticated-orcid":false,"given":"Ulya","family":"Uskent","sequence":"additional","affiliation":[{"name":"Gayrettepe Florence Nightingale Hospital,  T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"530","published-online":{"date-parts":[[2025]]},"reference":[{"issue":"5","key":"ref1","doi-asserted-by":"crossref","first-page":"972","DOI":"10.1097\/AOG.0000000000004120","article-title":"The case for standardizing cesarean delivery technique: seeing the forest for the trees","volume":"136","author":"Dahlke JD","year":"2020","journal-title":"Obstet Gynecol"},{"issue":"1","key":"ref2","article-title":"Efficacy of adjunctive azithromycin versus single-dose cephalosporin prophylaxis for caesarean scar defect: study protocol for a randomised controlled trial","volume":"10","author":"Cai Y","year":"2020","journal-title":"BMJ Open"},{"issue":"5","key":"ref3","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1590\/1806-9282.65.5.714","article-title":"Isthmocele: an overview of diagnosis and treatment","volume":"65","author":"Kremer TG","year":"2019","journal-title":"Rev Assoc Med Bras (1992)"},{"issue":"1","key":"ref4","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1002\/uog.6395","article-title":"High prevalence of defects in Cesarean section scars at transvaginal ultrasound examination","volume":"34","author":"Osser OV","year":"2009","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"4","key":"ref5","doi-asserted-by":"crossref","first-page":"372","DOI":"10.1002\/uog.13199","article-title":"Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review","volume":"43","author":"Bij Vaate AJ","year":"2014","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"ref6","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1002\/uog.19049","article-title":"Sonographic examination of uterine niche in non-pregnant women: a modified Delphi procedure","volume":"53","author":"Jordans IPM","year":"2019","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"6","key":"ref7","doi-asserted-by":"crossref","first-page":"440","DOI":"10.1007\/s13224-020-01370-0","article-title":"Post-caesarean niche (Isthmocele) in uterine scar: an update","volume":"70","author":"Kulshrestha V","year":"2020","journal-title":"J Obstet Gynaecol India"},{"issue":"4","key":"ref8","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1111\/aogs.13505","article-title":"The prevalence and risk predictors of cesarean scar defect at 6 weeks postpartum in Shanghai, China: a prospective cohort study","volume":"98","author":"Pan H","year":"2019","journal-title":"Acta Obstet Gynecol Scand"},{"issue":"5","key":"ref9","doi-asserted-by":"crossref","first-page":"578","DOI":"10.1002\/uog.17401","article-title":"Risk of cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials","volume":"50","author":"Spiezio Sardo A","year":"2017","journal-title":"Ultrasound Obstet Gynecol"},{"issue":"1","key":"ref10","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.ijgo.2011.04.013","article-title":"Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture","volume":"115","author":"Roberge S","year":"2011","journal-title":"Int J Gynaecol Obstet"},{"issue":"4","key":"ref11","doi-asserted-by":"crossref","first-page":"322","DOI":"10.4274\/tjod.galenos.2021.71173","article-title":"Effect of single- and double-layer cesarean section closure on residual myometrial thickness and isthmocele - a systematic review and meta-analysis","volume":"18","author":"Marchand GJ","year":"2021","journal-title":"Turk J Obstet Gynecol"},{"issue":"9","key":"ref12","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1111\/1471-0528.15048","article-title":"Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis","volume":"125","author":"Stegwee SI","year":"2018","journal-title":"BJOG"},{"issue":"11","key":"ref13","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1111\/j.1447-0756.2012.01872.x","article-title":"Ultrasonographic and hysteroscopic outcomes of uterine scar healing after cesarean section: comparison of two types of single-layer suture","volume":"38","author":"Ceci O","year":"2012","journal-title":"J Obstet Gynaecol Res"},{"issue":"12","key":"ref14","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1111\/aogs.13213","article-title":"Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single- or double-layer uterotomy closure: a randomized controlled trial","volume":"96","author":"Bamberg C","year":"2017","journal-title":"Acta Obstet Gynecol Scand"}],"container-title":["Revista da Associa\u00e7\u00e3o M\u00e9dica Brasileira"],"original-title":[],"link":[{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_pdf&pid=S0104-42302025000300612&tlng=en","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,2]],"date-time":"2025-05-02T11:07:02Z","timestamp":1746184022000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.scielo.br\/scielo.php?script=sci_arttext&pid=S0104-42302025000300612&tlng=en"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025]]},"references-count":14,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025]]}},"alternative-id":["S0104-42302025000300612"],"URL":"https:\/\/doi.org\/10.1590\/1806-9282.20241507","relation":{},"ISSN":["1806-9282","0104-4230"],"issn-type":[{"value":"1806-9282","type":"electronic"},{"value":"0104-4230","type":"print"}],"subject":[],"published":{"date-parts":[[2025]]},"article-number":"e20241507"}}