剖宫产时单层或双层子宫闭合与子宫瘢痕生态位风险：随机试验的系统回顾和荟萃分析

IF 2.5 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Archives of Gynecology and Obstetrics Pub Date : 2025-08-20 DOI:10.1007/s00404-025-08151-y

Mattia Dominoni, Marco Torella, Rossella Molitierno, Mario Fordellone, Gabriele Saccone, Dario Colacurci, Antonio Simone Laganà, Martina Rita Pano, Barbara Gardella, Marco La Verde

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引用次数: 0

摘要

目的：本系统综述和荟萃分析比较了剖宫产时单层和双层子宫闭合的效果。数据来源：MEDLINE， EMBASE, Scopus, ClinicalTrials.gov和Cochrane Central Register of Controlled Trials从成立到2024年5月检索。研究资格标准：我们只纳入比较剖宫产时单层和双层子宫闭合的随机对照试验（RTSs）。研究评价和综合方法：采用随机效应模型对结果进行分析。结果表示为风险差异。使用risk of bias 2工具对偏倚风险进行评估。主要结果是分娩后6个月疤痕缺损（即小生境）的发生率。次要结果是6周和3个月时疤痕缺损的发生率。结果：系统评价共纳入18项研究；meta分析纳入了11项随机对照试验，涉及6058名受试者。剖宫产切口单层与双层缝合6周子宫瘢痕缺损发生率比较，差异无统计学意义。单层封闭3个月后生态位发生率显著降低(RD = - 0.02 (- 0.06, 0.02)；I2 = 81%, p 2 = 91%， p结论：剖宫产时单层子宫关闭术在术后3个月和6个月子宫瘢痕缺损较双层子宫关闭术低。系统综述注册：PROSPERO，唯一标识符：CRD42024552495。

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Single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche: a systematic review and meta-analysis of randomized trials

Objective

This systematic review and meta-analysis compared single- versus double-layer uterine closure at the time of cesarean delivery.

Data sources

MEDLINE, EMBASE, Scopus, ClinicalTrials.gov, and Cochrane Central Register of Controlled Trials were searched from inception until May 2024.

Study eligibility criteria

We included only randomized controlled trials (RTSs) that compared single-layer versus double-layer uterine closure at the time of cesarean delivery.

Study appraisal and synthesis methods

Outcomes were analyzed using a random-effects model. Results are expressed as risk differences. The assessment of the risk of bias was performed by using the Risk of Bias 2 tool. The primary outcome was the incidence of scar defects (i.e., niche) at 6 months after delivery. The secondary outcomes were incidence of scar defects at 6 weeks and 3 months.

Results

A total of 18 studies were identified by the systematic review; 11 RCTs involving 6,058 participants were included in the meta-analysis. There is no statistical difference between single-layer and double-layer uterine closure of cesarean delivery incision regarding the incidence of uterine scar defect at six weeks. Single-layer closure showed a significantly lower incidence of niche after three months (RD = − 0.02 (− 0.06, 0.02); I² = 81%, p < 0.01), and six months (RD = − 0.11, CI − 0.15, − 0.07, I² = 91%, p < 0.01).

Conclusions

Single-layer uterine closure at the time of cesarean delivery resulted in a lower uterine scar defects after three and six months compared to double-layer uterine closure.

Systematic review registration

PROSPERO, Unique identifier: CRD42024552495.

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来源期刊

Archives of Gynecology and Obstetrics 医学-妇产科学

CiteScore

4.70

自引率

15.40%

发文量

493

审稿时长

1 months

期刊介绍： Founded in 1870 as "Archiv für Gynaekologie", Archives of Gynecology and Obstetrics has a long and outstanding tradition. Since 1922 the journal has been the Organ of the Deutsche Gesellschaft für Gynäkologie und Geburtshilfe. "The Archives of Gynecology and Obstetrics" is circulated in over 40 countries world wide and is indexed in "PubMed/Medline" and "Science Citation Index Expanded/Journal Citation Report". The journal publishes invited and submitted reviews; peer-reviewed original articles about clinical topics and basic research as well as news and views and guidelines and position statements from all sub-specialties in gynecology and obstetrics.