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Double-layered purse string uterine suture employing the French ambulatory cesarean section technique compared with single-layer continuous uterine suture: An ultrasound evaluation randomized trial.
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  • kaouther dimassi,
  • olivier ami,
  • rania merrai,
  • luka velemir,
  • benedicte simon,
  • denis fauck,
  • amel triki
kaouther dimassi
University of Tunis El Manar Faculty of Medicine of Tunis
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olivier ami
Ramsay Healthcare France, La Muette, Paris, France
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rania merrai
University of Tunis El Manar
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luka velemir
Lenval foundation Polyclinique Santa Maria, Nice, France.
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benedicte simon
Ramsay Healthcare France, Les Franciscaines, Versailles, France.
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denis fauck
Ramsay Healthcare France, Saint Lambert, La Garenne-Colombes, France
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amel triki
University of Tunis El Manar
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Abstract

Objective: To test the hypothesis that compared to single layer continuous uterine suture (SLCUS), a double layered purse string uterine suture (PSUS) significantly reduces cesarean scar defect (CSD) rates, without increasing the perioperative maternal morbidity. Design : Interventional prospective, randomized study . Setting: University obstetric units in Tunisia. Population: 100 pregnant women with an indication of a planned Caesarean. Methods: Patients were enrolled in 2 groups according to the uterine suture technique: SLCUS or PSUS. A Saline infusion hysterosonography was performed by the same senior obstetrician blinded to the uterine suture technique 6 months after surgery . Main Outcome measures: Operative time and Calculated blood loss (CBL) were used for the short time analysis . Uterine and CSD measurements were used for the mid time analysis . Results : Despite a few minutes longer operative time in SUS group (7.17 ± 2.31 min Vs. 6.31 ± 3.04 min, p = 0.028 in SLCUS group; p <10‾³); there was no significant difference in terms of CBL (520 ± 58 in SUS group vs. 536 ± 50 ml in SLCUS group, p = 0.724). The medium-term analysis showed a significant decrease in the rate of CSD with the PSUS: 6.66% vs.40% with SLUCS; p = 0.002. Moreover, SLUCS was the leading risk factor for CSD : adjusted OR=6 ;95% CI [0- 1],p < 10‾³) . Conclusion : Compared to single layer continuous suture, purse string uterine suture significantly reduces cesarean scar defect rates, without increasing the perioperative maternal morbidity. NCT03930134. https://clinicaltrials.gov/ct2/show/NCT03930134