Table 7Excluded studies and reasons for their exclusion

StudyReason for Exclusion
Abalos, E., Addo, V., Brocklehurst, P., El Sheikh, M. A., Farrell, B., Gray, S., Hardy, P., Juszczak, E., Mathews, J. E., Masood, S. N., Oyarzun, E., Oiyeke, J., Sharma, J., Spark, P., Caesarean section surgical techniques long term outcomes: Follow-up of the CORONIS trial, BJOG: An International Journal of Obstetrics and Gynaecology, 123, 30, 2016 [PubMed: 27627593] Conference abstract
Abalos, E., Oyarzun, E., Addo, V., Sharma, J. B., Matthews, J., Oyieke, J., Masood, S. N., El Sheikh, M. A., Brocklehurst, B., Farrell, F., Gray, S., Hardy, P., Jamieson, N., Juszczak, E., Spark, P., CORONIS - International study of caesarean section surgical techniques: The follow-up study, BMC Pregnancy and Childbirth, 13 (no pagination), 2013 CORONIS study protocol
Abraham, C., A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery, American Journal of Obstetrics and Gynecology, 219, 220–221, 2018 [PubMed: 29702067] Short communication/ Letter to the Editor
Adam, Y., Mwinyoglee, J., Masuku, B., Nicolaou, E., An evaluation of the indications for caesarean sections at Chris Hani Baragwanath academic Hospital, South African Journal of Obstetrics and Gynaecology, 24, 11–14, 2018 Retrospective cross-sectional study (non RCT)
Ahn, J. W., Lee, S. J., Kwon, Y. S., Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial, American Journal of Obstetrics and Gynecology, 216, 81–82, 2017 [PubMed: 27521463] Letter to the Editor (response to published article)
Babu, K. M., Magon, N., Uterine closure in cesarean delivery: A new technique, North American Journal of Medical Sciences, 4, 358–361, 2012 [PubMed: 22912945] Description of new techniques for closure (single layer excluding decidual layer)
Bamberg, C., Hinkson, L., Dudenhausen, J. W., Bujak, V., Kalache, K. D., Henrich, W., 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, Acta Obstetricia et Gynecologica Scandinavica, 96, 1484–1489, 2017 [PubMed: 28832909] No relevant outcomes (C-section scar niche observed by ultrasound)
Bamberg, Christian, Dudenhausen, Joachim W., Bujak, Verena, Rodekamp, Elke, Brauer, Martin, Hinkson, Larry, Kalache, Karim, Henrich, Wolfgang, A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness, Der Effekt auf die Narbendicke nach einschichtigem oder zweischichtigem Verschluss der Uterotomie bei der Sectio Cesarea: Eine prospektiv randomisierte Studie., 39, 343–351, 2018 Article in German
Batioglu, S., Kuscu, E., Duran, E. H., Haberal, A., One-layer closure of low segment transverse uterine incision by the Lembert technique, Journal of Gynecologic Surgery, 14, 11–14, 1998 No relevant outcomes
Belci, D., Di Renzo, G. C., Stark, M., Duric, J., Zoricic, D., Belci, M., Peteh, L. L., Morbidity and chronic pain following different techniques of caesarean section: A comparative study, Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology, 35, 442–6, 2015 [PubMed: 25384067] Compared traditional method and Misgav-Ladach method for C-section procedure (both use single layer, continuous locking suture for uterine closure)
Bennich, G., Rudnicki, M., Wilken-Jensen, C., Lousen, T., Lassen, P. D., Wojdemann, K., Impact of adding a second layer to a single unlocked closure of a Cesarean uterine incision: randomized controlled trial, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 47, 417–422, 2016 No relevant outcomes (Residual myometrial thickness, RMT, assessed by ultrasound)
Bij de Vaate, A. J., van der Voet, L. F., Naji, O., Witmer, M., Veersema, S., Brolmann, H. A., Bourne, T., Huirne, J. A., Prevalence, potential risk factors for development and symptoms related to the presence of uterine niches following Cesarean section: systematic review, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 43, 372–382, 2014 Systematic review: analyses cannot be used in entirety, included studies checked for inclusion (only 2 studies of relevance assessed for inclusion).
Bjorklund, K., Kimaro, M., Urassa, E., Lindmark, G., Introduction of the Misgav Ladach caesarean section at an African tertiary centre: a randomised controlled trial, BJOG: An International Journal of Obstetrics & Gynaecology, 107, 209–16, 2000 [PubMed: 10688504] Compared Misgav Ladach procedure and standard lower midline incision procedure (difference was transverse or longitudinal incision)
Blumenfeld, Yair, Caughey, Aaron B., Lyell, Deirdre J., Re: Uterine exteriorization compared with in situ repair at cesarean delivery: a randomized controlled trial, Obstetrics and Gynecology, 112, 183–183, 2008 Letter to the Editor regarding published article
Borowski, K., Andrews, J., Hocking, M., Hansen, W., Fleener, D., Syrop, C., Ultrasonographic detection of cesarean scar defects in a trial of single versus double layer closure, American Journal of Obstetrics and Gynecology, 197, S62, Abstract no: 183, 2007 Conference abstract
Brocklehurst, P., The CORONIS Trial: international study of caesarean section surgical techniques: a randomised fractional factorial randomised trial, BJOG: an international journal of obstetrics and gynaecology., 120, 3, 2013 [PubMed: 23678966] Conference abstract
Brocklehurst, P., Abalos, E., Addo, V., El Sheikh, M. A., Farrell, B., Gray, S., Hardy, P., Juszczak, E., Mathews, J. E., Masood, S. N., Oyarzun, E., Oiyeke, J., Sharma, J., Spark, P., Caesarean section surgical techniques long-term outcomes: Follow-up of the CORONIS trial, BJOG: An International Journal of Obstetrics and Gynaecology, 123, 12, 2016 [PubMed: 27627591] Conference abstract
Brocklehurst, P., Abalos, E., Addo, V., Sharma, J. B., Matthews, J., Oyieke, J., Naz Masood, S., El Sheikh, M. A., The CORONIS Trial. International study of caesarean section surgical techniques: A randomised fractional, factorial trial, BMC Pregnancy and Childbirth, 7, 24, 2007 [PubMed: 18336721] CORONIS study protocol
Bujold, E., The optimal uterine closure technique during caesarean, North American Journal of Medical Sciences, 4, 362–363, 2012 [PubMed: 22912946] Short communication
Capmas, P., Guyot, A., Stirnemann, J., Ville, Y., Fernandez, H., Comparing sonographic aspect of cesarean scar after a continuous single-or double-layer suture: a randomized trial, Journal of Minimally Invasive Gynecology, 20, S165, 2013 Conference abstract
Cardona-Osuna, M. E., Avila-Vergara, M. A., Peraza-Garay, F., Meneses-Valderrama, V., Flores-Pompa, E., Corrales-López, A., Comparison of pregnancy outcomes Caesarean techniques: modified Misgav-Ladach, Pfannenstiel-Kerr and Kerr-half infraumbilical, Ginecologia y Obstetricia de Mexico, 84, 514–522, 2016 [PubMed: 29424513] Article in Spanish
Catling-Paull, Christine, Johnston, Rebecca, Ryan, Clare, Foureur, Maralyn J., Homer, Caroline S. E., Clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review, Journal of advanced nursing, 67, 1646–61, 2011 [PubMed: 21477118] Systematic review: analyses cannot be used in entirety, included studies checked for inclusion (2 studies - follow up of one RCT - assessed for inclusion).
Ceci, O., Scioscia, M., Bettocchi, S., Cantatore, C., Nardelli, C., Laera, A., Vimercati, A., Ultrasound evaluation of the uterine scar after cesarean delivery: A randomized controlled trial of one- and two-layer closure, Obstetrics and Gynecology, 111, 452, 2008 Letter to the Editor regarding published article
Chamberlain, G., Steer, P., ABC of labour care: operative delivery, BMJ (Clinical research ed.), 318, 1260–4, 1999 Description of c-section procedure (educational material)
Charoenkwan, K., Double-layer continuous parallel uterine closure for low transverse cesarean incisions, International Journal of Gynecology and Obstetrics, 94, 137–138, 2006 [PubMed: 16828482] Short communication regarding two-layer technique
Chauhan, R., Nagrath, A., Mathura, V., Singh, S., Mathur, R. K., Comparison of single layer closure with conventional multilayer closure of the abdominal wall in caesarean section, Journal of obstetrics and gynaecology of India, 52, 33–36, 2002 No relevant outcomes. Unclear if women were randomly allocated to study or “control” groups. Multi-layer (study group) closure: (1) peritoneum closure, (2) rectus sheath closure, (3) subcutaneous closure. Single layer (control) closure of peritoneum, rectus sheath, subcutaneous using round body needle
Corso, E., Hind, D., Beever, D., Fuller, G., Wilson, M. J., Wrench, I. J., Chambers, D., Enhanced recovery after elective caesarean: a rapid review of clinical protocols, and an umbrella review of systematic reviews, BMC Pregnancy & Childbirth, 17, 91, 2017 [PubMed: 28320342] No relevant outcomes
Coutinho, I. C., Ramos de Amorim, M. M., Katz, L., Bandeira de Ferraz, A. A., Uterine exteriorization compared with in situ repair at cesarean delivery: a randomized controlled trial, Obstetrics and Gynecology, 111, 639–647, 2008 [PubMed: 18310366] Compared exteriorized and in-situ repair of uterine wall (uterine incision was closed with a continuous single layer)
Dahlke,J.D., Mendez-Figueroa,H., Rouse,D.J., Berghella,V., Baxter,J.K., Chauhan,S.P., Evidence-based surgery for cesarean delivery: An updated systematic review, American Journal of Obstetrics and Gynecology, 209, 294–306, 2013 [PubMed: 23467047] Systematic review with no relevant outcomes. 3 references checked and assessed for inclusion.
Dani C, , Reali M, , Oliveto R, , Temporin G, , Bertini G,, Rubaltelli F. , Short-term outcome of newborn infants born by a modified procedure of cesarean section: a prospective randomized study, Acta Obstetricia et Gynecologica Scandinavica, 77, 929–31, 1998 [PubMed: 9808382] No relevant outcomes (neonatal outcomes only)
Di Spiezio Sardo, A., Saccone, G., McCurdy, R., Bujold, E., Bifulco, G., Berghella, V., Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 50, 578–583, 2017 Systematic review: analyses cannot be used in entirety, included studies checked for inclusion (included studies with relevant outcomes already included).
Dodd, J. M., Anderson, E. R., Gates, S., Surgical techniques for uterine incision and uterine closure at the time of caesarean section, Cochrane Database of Systematic Reviews, CD004732, 2008 More recent version assessed for inclusion
Dodd, J. M., Anderson, E. R., Gates, S., Grivell, R. M., Surgical techniques for uterine incision and uterine closure at the time of caesarean section, Cochrane Database of Systematic Reviews, 7, CD004732, 2014 Systematic review: analyses cannot be used in entirety, included studies checked for inclusion
Dodson, M. K., Magann, E. F., Meeks, G. R., A randomized comparison of secondary closure and secondary intention in patients with superficial wound dehiscence, Obstetrics and Gynecology, 80, 321–4, 1992 [PubMed: 1495686] Skin closure
E. Mathews J, Ashworth, F., Chippington Derrick, D., Cousens, S., Neilson, J., Purwar, M., Roberts, M., Waddington, C., Bewley, S., Campbell, O., Deeks, J., Mirembe, F., El Sheikh, M., Farrell, B., Gray, S., Mathews, J. E., Sharma, J. B., Armstrong, N., Bowler, U., Brocklehurst, P., Farrell, B., Gray, S., Hardy, P., Juszczak, E., Nowicki, M., Quigley, M., Spark, P., Zhao, R., Abalos, E., Burqueno, N. F., Campodonico, L., Carroli, B., D’Aloisio, L., Dalonso, M., Giordano, D., Novaro, J., Toumani, B., Zanello, R., Garay, C., Ihnen, O., Mora, S., Oyarzun, E., Addo, V., Ansah, A., Asamoa, P., Ashong, R., Attrams, I., Boateng, K., Senya, L., Bahadur, A., Batra, D., Chaudhary, A., Devi, S. G., Dhanai, S., Dharmendra, S., Gandhi, S., Gupta, A., Gupta, H., Kumar, M., Kumar, N., Kumar, P., Kumar, V., Kumari, S., Naha, M., Pushpraj, M., Roy, B. K., Shankar, M., Sharma, J. B., Sharma, S., Shukla, H., Singla, S., Wangdi, T., Nayana, E. J., Jacob, S., Mathews, J. E., Thomas, W., Jeyasudha, R., Nirmala, M., Sukumar, K., Bwana, K. M., Mulange, J., Ndeda, M., O’Goro, K., Okoti, D., Oyieke, J., Abdul Muhammad, Z., Ali, A., Arain, S., Bhatia, J., Bibi, F., Imran Shah, S., Malik, S., Naz Masood, S., Rafiq, S., Rizvi, S., Soomro, S., Abdelhafiz, Z., El Sheikh, E., El Sheikh, M., El Sheikh, T., Etayeb, E., Hamad, T., Hashim, A., Khatim, M., Mohamed, S., Yousif, A., Arias, C. A., Bosquiazzo, L. M., Bruna, J. A., Fabrica, M. C., Mascotti, C., Bertin, M. S., Castaldi, J. L., Mendoza, S. J., Partida, L. Y., Zyla, A., Castilla, L., Di Gerolano, E., Espinoza, M., Koch, G., Tulian, M., Melis, M., Miriam, M., Palermo, M., Pappalardo, J., Quinones, M., Cabrera, F., Campos, S., Curioni, M. A., Fernandez, J., Grasselli, C., Abarzua, F., Araya, G., Caro, M., Gonzalez, C., Vera, C., Araneda, M., De La Cuadra, S., Kusanovic, J. P., Ortiz, J. A., Silva, K., Bofa, W. K., Djokoto, R. M., Konney, T. O., Larbi, Y. O., Quashie, E., Kriplani, A., Kumar, S., Mittal, S., Gupta, U., Puri, M., Raghunandan, C., Trivedi, S. S., Batra, S., Kumar, A., Manaktala, U., Prasad, S., Goel, N., Guleria, K., Radhakrishnan, G., Suneja, A., Vaid, N. B., Beck, M., D’Souza, A., Sebastian, A., Thomas, A. E., Thomas, E., Vijayaselvi, R., Butt, F., Kaliti, S., Nyaboga, E. O., Owiti, M. J., Wameyo, A., Akram, S., Junejo, A., Khatoon, J., Siddiqui, S., Zafar, S., Abbasi, F., Aijaz, S., Firdous, A., Khuwaja, A., Zulfiqar, B., Batool, S., Hashmi, H., Hussaini, S., Naqvi, Z., Tahir, S., Ibrahim, S., Khalil, S. E., Kuna, A., Saboni, M., Salman, M., Abubakar, M. S., Awad, M., Elbashir, M., Gaffar, N., Hussain, S., Caesarean section surgical techniques (CORONIS): A fractional, factorial, unmasked, randomised controlled trial, Journal of Obstetrics and Gynaecology Research, 41, 23–24, 2015 Conference abstract
El-Khayat, W., Elsharkawi, M., Hassan, A., A randomized controlled trial of uterine exteriorization versus in situ repair of the uterine incision during cesarean delivery, International journal of gynaecology and obstetrics, 127, 163–166, 2014 [PubMed: 25005057] Compared extra-abdominal and in-situ repair of uterine incision (uterus was closed with absorbable continuous Vicryl 1 sutures in a continuous double layer)
El-Sokkary, M., Wahba, K., El-Shahawy, Y., Uterine salvage management for atonic postpartum hemorrhage using “modified lynch suture”, BMC Pregnancy and Childbirth, 16, 251, 2016 [PubMed: 27567670] Not relevant population or comparison (women who suffered from PPH during lower segment caesarean section and were not responding to uterotonics were operated upon by the modified technique or the classic B-lynch)
Enkin, M. W., Wilkinson, C., WITHDRAWN: Single versus two layer suturing for closing the uterine incision at Caesarean section, Cochrane database of systematic reviews (Online), CD000192, 2007 Withdrawn and replaced with more recent review; Dodd 2014
Enkin, M. W., Wilkinson, C., Single versus two layer suturing for closing the uterine incision at caesarean section, Cochrane Database of Systematic Reviews, CD000192, 2000 Withdrawn and replaced with more recent review; Dodd 2014
Enkin, M. W., Wilkinson, C. S., Single versus two layer suturing for closing the uterine incision at Caesarean section, Cochrane Database of Systematic Reviews, 2006 Withdrawn and replaced with more recent review; Dodd 2014
Ezechi, O. C., Kalu, B. K., Njokanma, F. O., Nwokoro, C. A., Okeke, G. C., Uterine incision closure at caesarean section: a randomised comparative study of intraperitoneal closure and closure after temporary exteriorisation, West african journal of medicine, 24, 41–43, 2005 [PubMed: 15909709] Compared exteriorization and in-situ uterine repair (two layer closure of uterine incision)
Farrell, B., The CORONIS trial: International study of caesarean section surgical techniques-a randomised non-regular fractional, factorial trial, Clinical Trials, 10, S50, 2013 Conference abstract
Ferrari, A. G., Frigerio, L. G., Candotti, G., Buscaglia, M., Petrone, M., Taglioretti, A., Calori, G., Can Joel-Cohen incision and single layer reconstruction reduce cesarean section morbidity?, International Journal of Gynaecology & Obstetrics, 72, 135–43, 2001 [PubMed: 11166746] Compared classic C-section technique with “modified technique” (different incision, exteriorization, closure). No relevant outcomes reported
Franchi, M., Ghezzi, F., Balestreri, D., Beretta, P., Maymon, E., Miglierina, M., Bolis, P. F., A randomized clinical trial of two surgical techniques for cesarean section, American Journal of Perinatology, 15, 589–94, 1998 [PubMed: 9926882] Compared Joel-Cohen incision with the parietal and pelvic peritoneum left open, and the Pfannenstiel incision with both peritoneal layers sutured (continuous single layer non-locking uterine closure in all)
Gaskin, I. M., Concerns about single-layer suturing of the uterus after cesarean surgery, Midwifery today with international midwife, 32–34, 2002 [PubMed: 12101914] Oral presentation
Gezginc, Kazim, Yazici, Fatma, Koyuncu, Tuba, Results of hysterosalpingogram in women with previous B-Lynch suture, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 115, 68–9, 2011 Short communication; case-series
Gutiérrez, J. G., Coló, J. A., Arreola, M. S., Comparative trial between traditional cesarean section and Misgav-Ladach technique, Ginecologia y Obstetricia de Mexico, 76, 75–80, 2008 [PubMed: 18798399] Article in Spanish
Gyamfi, C., Juhasz, G., Gyamfi, P., Blumenfeld, Y., Stone, J. L., Single- versus double-layer uterine incision closure and uterine rupture, Journal of Maternal-Fetal & Neonatal Medicine, 19, 639–43, 2006 [PubMed: 17118738] Non RCT (retrospective cohort/case-control)
Hamar, B. D., Saber, S. B., Cackovic, M., Magloire, L. K., Pettker, C. M., Abdel-Razeq, S. S., Rosenberg, V. A., Buhimschi, I. A., Buhimschi, C. S., Ultrasound evaluation of the uterine scar after cesarean delivery: a randomized controlled trial of one- and two-layer closure, Obstetrics and Gynecology, 110, 808–813, 2007 [PubMed: 17906013] No relevant outcomes
Hamar, B. R., Saber, S. B., Cackovic, M., Magloire, L. K., Pettker, C. M., Abdel-Razeq, S. S., Ultrasound evaluation of uterine incision healing after cesarean delivery - a randomized controlled study of one- versus two-layer closure, American Journal of Obstetrics and Gynecology, 195, S57, 2006 Conference abstract
Hamid,R., Arulkumaran,S., Management of scarred uterus in subsequent pregnancies, Current Obstetrics and Gynaecology, 16, 168–173, 2006 Narrative review
Hayakawa,H., Itakura,A., Mitsui,T., Okada,M., Suzuki,M., Tamakoshi,K., Kikkawa,F., Methods for myometrium closure and other factors impacting effects on cesarean section scars of the uterine segment detected by the ultrasonography, Acta Obstetricia et Gynecologica Scandinavica, 85, 429–434, 2006 [PubMed: 16612704] No relevant outcomes (wedge defects one month post-partum)
Hegde, C. V., The never ending debate single-layer versus double-layer closure of the uterine incision at cesarean section, Journal of obstetrics and gynaecology of India, 64, 239–40, 2014 [PubMed: 25136167] Narrative, short communication
Hofmeyr,J.G., Novikova,N., Mathai,M., Shah,A., Techniques for cesarean section, American Journal of Obstetrics and Gynecology, 201, 431–444, 2009 [PubMed: 19879392] Systematic review: analyses cannot be used in entirety, included studies checked for inclusion (examined complete methods/technique of C-section, not individual aspects).
Humphries, G., Suturing a cesarean wound, Midwifery today with international midwife, 22–3, 2001 Oral presentation
Jacobs-Jokhan, D., Hofmeyr, G., Extra-abdominal versus intra-abdominal repair of the uterine incision at caesarean section, Cochrane Database of Systematic Reviews, CD000085, 2004 Compared extra-abdominal and intra-abdominal repair of uterine incision
Jacobs-Jokhan, D., Hofmeyr, G. J., Extra-abdominal versus intra-abdominal repair of the uterine incision at caesarean section, Cochrane Database of Systematic Reviews, 2004 Duplicate of 387390 (Cochrane SR, Jacobs-Jokhan 2004)
Jacobson, P., Improved uterine closure in classical cesarean section, Western journal of surgery, obstetrics, and gynecology, 59, 431–3, 1951 Narrative overview
Juszczak, E., Farrell, B., The CORONIS Trial: International study of caesarean section surgical techniques, Trials. Conference: Clinical Trials Methodology Conference, 12, 2011 Poster presentation
Kostu, B., Ercan, O., Ozer, A., Bakacak, M., Ozdemir, O., Avci, F., A comparison of two techniques of uterine closure in caesarean section, Journal of Maternal-Fetal and Neonatal Medicine, 29, 1573–1576, 2016 [PubMed: 26100763] No relevant intervention (compared direction the surgeon pulled suture during closure)
Kumar, S., Single versus double layer closure of low transverse uterine incision at cesarean section, Journal of obstetrics and gynaecology of India, 55, 231–236, 2005 Duplicate (Sood et al 2005)
Lal, K., Tsomo, P., Comparative study of single layer and conventional closure of uterine incision in cesarean section, International journal of gynaecology and obstetrics, 27, 349–352, 1988 [PubMed: 2904896] No relevant outcomes (scar deformities visualised by ultrasound)
Landon,M.B., Vaginal birth after cesarean delivery, Clinics in Perinatology, 35, 491–504, 2008 [PubMed: 18952017] Narrative review
Matsubara, Shigeki, Yano, Hitoshi, Ohkuchi, Akihide, Kuwata, Tomoyuki, Usui, Rie, Suzuki, Mitsuaki, Uterine compression sutures for postpartum hemorrhage: an overview, Acta Obstetricia et Gynecologica Scandinavica, 92, 378–85, 2013 [PubMed: 23330882] Narrative review regarding brace sutures
Mazhar, S. B., Mahsood, S., Single versus double layer uterine closure during cesarean section: a randomised trial, 30th british congress of obstetrics and gynaecology; 2004 july 7–9; glasgow, UK, 63, 2004 Conference abstract
Moreira, P., Moreau, J. C., Faye, M. E., Ka, S., Kane Gueye, S. M., Faye, E. O., Comparison of two cesarean techniques: classic versus misgav ladach cesarean]. [French, Journal de gynecologie, obstetrique ET biologie de la reproduction, 31, 572–576, 2002 Article in French
Mukhopadhyay, B., Single layer - vs - two layer closure of uterus during caesarean section - an institutional experience, XVI FIGO world congress of obstetrics & gynecology (book 3); 2000 sept 3–8; washington dc, USA, 43, 2000 Conference abstract
Najam, A., Sial, S., Basharat, A., Usmani, A., Jamil, M., Comparison of perioperative complications between modified Misgav Ladach and Pfannenstiel technique of caesarean section: a randomised controlled trial at a tertiary care hospital, Pakistan, BJOG: an international journal of obstetrics and gynaecology. Conference: 2018 world congress of the royal college of obstretriscians and gynaecologists, RCOG 2018. Singapore, 125, 67, 2018 Conference abstract
Naz Masood, S., Caesarean section surgical techniques (CORONIS): a fractional, factorial, unmasked, randomised controlled trial, Journal of maternal-fetal and neonatal medicine., 27, 16, 2014 Conference abstract
Nct,, Closure of Uterine Incision by Single or Double Layer Technique, Https:​//clinicaltrials​.gov/show/nct02144805, 2014 Clinical trial record (completed - no known publications)
Nct,, Impact of Double-layer Versus Single-layer Uterine Closure Suture in Cesarean Section on the Development of Postoperative Uterine Scar Deficiency, Https:​//clinicaltrials​.gov/show/nct03039803, 2016 Clinical trial record (ongoing trial, actively recruiting)
Nct,, Seprafilm® for Prevention of Adhesions at Repeat Cesarean, Https:​//clinicaltrials​.gov/show/nct00697606, 2008 Clinical trial record (terminated due to lack of funding)
Nct,, Study to Compare Suture Material in Closure of Uterine Incision in Cesarian Section, Https:​//clinicaltrials​.gov/show/nct02517710, 2014 Clinical trial record (completed - no known publications)
Nct,, Trial Comparing Barbed and Non-barbed Suture for Uterine Incision Closure at Cesarean Section, Https:​//clinicaltrials​.gov/show/nct02962011, 2016 Clinical trial register (completed - no known publications)
Nct,, Long Term Comparison of Two Different Techniques of Uterine Cesarean Incision Closure, Https:​//clinicaltrials​.gov/show/nct01289262, 2011 Clinical trial record (completed - no known publications)
Nct,, Plication of the Rectus Abdominis in Two Planes and in One Continuous Suture Plan, Https:​//clinicaltrials​.gov/show/nct02674035, 2015 Clinical trial record (completed - no known publications)
Nct,, Rectus Muscle Re-approximation at Cesarean Delivery, Https:​//clinicaltrials​.gov/show/nct03296969, 2017 Clinical trial record (ongoing trial, not yet recruiting)
Nct,, Suture of UTerus and Ultrasound Repair Evaluation, Https:​//clinicaltrials​.gov/show/nct01860859, 2013 Clinical trial record (completed -no known publications)
Nct,, NIche Development With Closure of Cesarean Uterotomy by Modified or Conventional Two-layer Technique, Https:​//clinicaltrials​.gov/show/nct02410395, 2015 Clinical trial record (ongoing trial, no longer recruiting)
Nct,, Impact of Uterine Closure Techniques on the Cesarean Scar Thickness After Repeated Cesarean Section, Https:​//clinicaltrials​.gov/show/nct03644433, 2018 Clinical trial record (ongoing trial, actively recruiting)
O’Leary, J. L., O’Leary, J. A., Uterine artery ligation for control of postcesarean section hemorrhage, Obstetrics and Gynecology, 43, 849–53, 1974 [PubMed: 4597790] Ligation of uterine artery to control post c-section haemorrhage
Olyaeemanesh, Alireza, Bavandpour, Elahe, Mobinizadeh, Mohammadreza, Ashrafinia, Mansoor, Bavandpour, Maryam, Nouhi, Mojtaba, Comparison of the Joel-Cohen-based technique and the transverse Pfannenstiel for caesarean section for safety and effectiveness: A systematic review and meta-analysis, Medical journal of the Islamic Republic of Iran, 31, 54, 2017 [PubMed: 29445683] No relevant outcomes. SR compared vertical Joel-Cohen-based and transverse Pfannenstiel incision (focus on incision)
Paglia, M. J., Parham, T., Sinclair, T., Murtha, A. P., Dermal closure time in cesarean delivery Pfannenstiel incision using a barbed suture, Obstetrics and Gynecology, 105, 32S, 2005 Conference abstract
Paglia, M., Sinclair, T., Murtha, A., Evaluation of a novel technique for cesarean section closure via Pfannenstiel incision using a barbed suture, American Journal of Obstetrics and Gynecology, 191, S155, 2004 Conference abstract
Park, I. Y., Kim, M. R., Lee, H. N., Gen, Y., Kim, M. J., Risk factors for Korean women to develop an isthmocele after a cesarean section, BMC Pregnancy and Childbirth, 18, 162, 2018 [PubMed: 29764452] Non RCT (case-control study of women who underwent C-section and had an isthmocele)
Peleg, D., Ahmad, R. S., Warsof, S. L., Marcus-Braun, N., Sciaky-Tamir, Y., Ben Shachar, I., A randomized clinical trial of knotless barbed suture vs conventional suture for closure of the uterine incision at cesarean delivery, American Journal of Obstetrics and Gynecology, 218, 343.e1–343.e7, 2018 [PubMed: 29496259] Compared knotless barbed and conventional sutures (in all cases the uterine incision was closed in 2 layers)
Peleg, D., Ahmad, R. S., Warsof, S. L., Marcus-Braun, N., Sciaky-Tamir, Y., Shachar, I. B., Knotless barbed suture closure of the uterine incision at cesarean-a randomized controlled trial, American journal of obstetrics and gynecology. Conference: 38th annual meeting of the society for maternal-fetal medicine: the pregnancy meeting. United states, 218, S25, 2018 Conference abstract
Roberge, S., Bujold, E., Single versus double layer closure and risk of uterine rupture: Systematic review and meta-analysis, American Journal of Obstetrics and Gynecology, 201, S198, 2009 Conference abstract
Roberge, S., Chaillet, N., Boutin, A., Moore, L., Jastrow, N., Brassard, N., Gauthier, R. J., Hudic, I., Shipp, T. D., Weimar, C. H. E., Fatusic, Z., Demers, S., Bujold, E., Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture, International Journal of Gynecology and Obstetrics, 115, 5–10, 2011 [PubMed: 21794864] Systematic review: analyses cannot be used in entirety, included studies (cohort and case-control trials, and 1 RCT) checked for inclusion
Roberge, S., Demers, S., Berghella, V., Chaillet, N., Moore, L., Bujold, E., Impact of single- vs double-layer closure on adverse outcomes and uterine scar defect: A systematic review and metaanalysis, American Journal of Obstetrics and Gynecology, 211, 453–460, 2014 [PubMed: 24912096] Systematic review: only 2 RCTs relevant, assessed for inclusion
Roberge, S., Demers, S., Girard, M., Vikhareva, O., Markey, S., Chaillet, N., Moore, L., Paris, G., Bujold, E., Impact of uterine closure on residual myometrial thickness after cesarean: a randomized controlled trial, American Journal of Obstetrics and Gynecology, 214, 507.e1–507.e6, 2016 [PubMed: 26522861] No relevant outcomes
Rozenberg, P., Re: Risk of Cesarean scar defect following single- vs double-layer uterine closure: systematic review and meta-analysis of randomized controlled trials. A. Di Spiezio Sardo, G. Saccone, R. McCurdy, E. Bujold, G. Bifulco and V. Berghella. Ultrasound Obstet Gynecol 2017; 50: 578–583, Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology, 50, 557–558, 2017 [PubMed: 28070914] Short communication/Letter to the Editor
Sahin, N., Genc, M., Turan, G. A., Kasap, E., Guclu, S., A comparison of 2 cesarean section methods, modified Misgav-Ladach and Pfannenstiel-Kerr: a randomized controlled study, Advances in clinical and experimental medicine, 27, 357–361, 2018 [PubMed: 29533540] Compared Pfannestiel-Kerr and modified Misgav-Ladach method (both used single layer continuous sutures for uterine closure)
Scioscia, M., Iannone, P., Morano, D., Pontrelli, G., Greco, P., Comment on “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”, Acta Obstetricia et Gynecologica Scandinavica, (no pagination), 2018 Letter to the Editor
Sevket, O., Ates, S., Molla, T., Ozkal, F., Uysal, O., Dansuk, R., Hydrosonographic assessment of the effects of 2 different suturing techniques on healing of the uterine scar after cesarean delivery, International journal of gynaecology and obstetrics, 125, 219–222, 2014 [PubMed: 24680843] No relevant outcomes
Shan, D., Mathew, B. S., Wu, Y., Hu, Y., Qiu, P., New lower segment repairing surgery to control bleeding in repeated caesarean section, a randomized controlled trail, International Journal of Clinical and Experimental Medicine, 11, 3932–3939, 2018 No relevant outcomes. Compared new suture method for repeat c-section and standard c-section technique
Shi, Z., Ma, L., Yang, Y., Wang, H., Schreiber, A., Li, X., Tai, S., Zhao, X., Teng, J., Zhang, L., Lu, W., An, Y., Alla, N. R., Cui, T., Adhesion formation after previous caesarean section-a meta-analysis and systematic review, BJOG: An International Journal of Obstetrics & Gynaecology, 118, 410–22, 2011 [PubMed: 21176087] Systematic review, based on retrospective observational studies (not RCTs); comparison of 3 caesarean sections procedures
Shmakov, R. G., Vinitskiy, A. A., Chuprinin, V. D., Yarotskaya, E. L., Sukhikh, G. T., Alternative approaches to surgical hemostasis in patients with morbidly adherent placenta undergoing fertility-sparing surgery, Journal of Maternal-Fetal and Neonatal Medicine, 1–7, 2018 Ligation techniques of uterine artery/internal iliac arteries/ common iliac artery
Shrestha, Pravin, Shrestha, Smita, Gyawali, Merina, Ultrasound Evaluation of Uterine Scar in Primary Caesarean Section: A Study of Single versus Double Layer Uterine Closure, American Journal of Public Health Research, 3, 178–181, 2015 No relevant outcomes (scar thickness by ultrasound)
Sivasuriya, M., Sriskanthan, R., Sriskandarajah, M. N., A new technique for closure of the uterus at Caesarean section, Australian and New Zealand Journal of Obstetrics and Gynaecology, 28, 96–98, 1988 [PubMed: 3265871] Narrative review, description of single layer technique
Stark, M., Evidence-based facts concerning caesarean section, Journal of Maternal-Fetal and Neonatal Medicine, 23, 72, 2010 Conference abstract
Stegwee, S. I., Jordans, I. P. M., van der Voet, L. F., van de Ven, P. M., Ket, J. C. F., Lambalk, C. B., de Groot, C. J. M., Hehenkamp, W. J. K., Huirne, J. A. F., Uterine caesarean closure techniques affect ultrasound findings and maternal outcomes: a systematic review and meta-analysis, BJOG: An International Journal of Obstetrics and Gynaecology, 125, 1097–1108, 2018 [PubMed: 29215795] Systematic review: analyses cannot be used in entirety, included studies checked for inclusion (no relevant outcomes).
Studzinski Z. , The Misgav-Ladach method for cesarean section compared to the Pfannenstiel technique [Ciecie cesarskie sposobem Misgav-Ladach w porownaniu z technika Pfannenstiela]., Ginekologia Polska, 73, 672–6, 2002 [PubMed: 12369293] Article in Polish
Surico, D., Amadori, R., Vigone, A., D’Agostino, C., Dessole, M., Surico, N., Successful delivery after surgical repair of uterine rupture at 15 weeks of gestation: case report and brief review, European Journal of Obstetrics Gynecology and Reproductive Biology, 204, 5–8, 2016 Case-series
Tekiner, N. B., Cetin, B. A., Turkgeldi, L. S., Yilmaz, G., Polat, I., Gedikbasi, A., Evaluation of cesarean scar after single- and double-layer hysterotomy closure: a prospective cross-sectional study, Archives of Gynecology and Obstetrics, 297, 1137–1143, 2018 [PubMed: 29397441] No relevant outcomes (scar defects)
Tucker, J. M., Hauth, J. C., Hodgkins, P., Owen, J., Winkler, C. L., Trial of labor after a one- or two-layer closure of a low transverse uterine incision, American Journal of Obstetrics and Gynecology, 168, 545–546, 1993 [PubMed: 8438925] Non RCT (retrospective cohort)
Turan, C., Buyukbayrak, E. E., Onan Yilmaz, A., Karageyim Karsidag, Y., Pirimoglu, M., Purse-string double-layer closure: a novel technique for repairing the uterine incision during cesarean section, Journal of Obstetrics and Gynaecology Research, 41, 565–574, 2015 Compares new form of double layer closure to classic double layer closure (intervention should be single layer closure)
Turan, G. A., Gur, E. B., Tatar, S., Gokduman, A., Guclu, S., Uterine closure with unlocked suture in cesarean section: safety and quality, Pakistan journal of medical sciences, 30, 2014 Compared locked and unlocked sutures (all single layer closure of uterus)
Unterscheider, J., Kent, E., Murray, A., Flood, K., Breathnach, F., Malone, F. D., Single versus double layer closure at caesarean delivery-an ongoing debate, Irish Journal of Medical Science, 180, S157, 2011 Conference abstract
Vachon-Marceau, C., Demers, S., Bujold, E., Roberge, S., Gauthier, R. J., Pasquier, J. C., Girard, M., Chaillet, N., Boulvain, M., Jastrow, N., Single versus double-layer uterine closure at cesarean: impact on lower uterine segment thickness at next pregnancy, American journal of obstetrics and gynecology., 05, 2017 Non RCT (secondary analysis of prospective cohort study); no relevant outcomes (lower uterine segment thickness)
van Dongen, P. W., Nijhuis, J. G., Jongsma, H. W., Reduced blood loss during caesarean section due to a controlled stapling technique, European Journal of Obstetrics, Gynecology, & Reproductive BiologyEur J Obstet Gynecol Reprod Biol, 32, 95–102, 1989 Intervention: use of staples to “seal blood vessels and all three uterine layers” before uterine incision
Wahab,M.A., Karantzis,P., Eccersley,P.S., Russell,I.F., Thompson,J.W., Lindow,S.W., A randomised, controlled study of uterine exteriorisation and repair at caesarean section, British Journal of Obstetrics and Gynaecology, 106, 913–916, 1999 [PubMed: 10492101] Compared exteriorization and in-situ uterine repair (double layer closure of uterine incision in all cases)
Wallin, G., Fall, O., Modified joel-cohen technique for caesarean section. A prospective randomised study, Acta Obstetricia et Gynecologica Scandinavica, 76 Suppl, 24, 1997 Abstract only/ short communication
Wallin, G., Fall, O., Modified Joel-Cohen technique for caesarean delivery, British Journal of Obstetrics and Gynaecology, 106, 221–226, 1999 [PubMed: 10426640] Compared Joel-Cohen technique and Pfannenstiel technique (both used interrupted sutures in one layer)
Walsh,C.A., Evidence-based cesarean technique, Current Opinion in Obstetrics and Gynecology, 22, 110–115, 2010 [PubMed: 20216417] Narrative review. Relevant references checked and assessed for inclusion
Waniorek, A., Hysterography after cesarean section for evaluation of suturing technic, Obstetrics and Gynecology, 29, 192–199, 1967 [PubMed: 5334991] No relevant outcomes (scar deformity)
Wilkinson, C., Enkin, M. W., Uterine exteriorization versus intraperitoneal repair at caesarean section, Cochrane Database of Systematic Reviews, CD000085, 2000 Compared exteriorization and in-situ repair of uterine incision
Wojdemann, K., Bennich, G., Long term follow-up from a randomized trial comparing one- and two-layer closure techniques in caesarean section (cs), Ultrasound in obstetrics & gynecology, 36, 141, 2010 [PubMed: 20503238] Conference abstract
Xu, Dabao, Cheng, Chunxia, Xue, Min, Wan, Yajun, Retained permanent uterine suture after cesarean, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 100, 78–9, 2008 Short communication
Yazicioglu, F., Gokdogan, A., Kelekci, S., Aygun, M., Savan, K., Incomplete healing of the uterine incision after caesarean section: Is it preventable?, European Journal of Obstetrics Gynecology and Reproductive Biology, 124, 32–36, 2006 Compared suturing techniques: full thickness including the endometrial (decidual) layer, and split thickness excluding the endometrial layer (both used single layer continuous locking sutures)
Ying, Hao, Duan, Tao, Bao, Yi-Rong, Song, Yue-Hua, Wang, De-Fen, Transverse annular compression sutures in the lower uterine segment to control postpartum hemorrhage at cesarean delivery for complete placenta previa, International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 108, 247–8, 2010 Short communication
Zaphiratos, Valerie, George, Ronald B., Boyd, J. Colin, Habib, Ashraf S., Uterine exteriorization compared with in situ repair for Cesarean delivery: a systematic review and meta-analysis, Canadian journal of anaesthesia = Journal canadien d’anesthesie, 62, 1209–20, 2015 Systematic review compared exteriorization and in-situ uterine repair
Zayed, M. A., Fouda, U. M., Elsetohy, K. A., Zayed, S. M., Hashem, A. T., Youssef, M. A., Barbed sutures versus conventional sutures for uterine closure at cesarean section; a randomized controlled trial, Journal of Maternal-Fetal and Neonatal Medicine, 1–8, 2017 Compared barbed and conventional sutures in uterine closure (both used two-layer uterine closure)

From: Techniques to close the uterus at caesarean birth

Cover of Techniques to close the uterus at caesarean birth
Techniques to close the uterus at caesarean birth: Caesarean birth: Evidence review D.
NICE Guideline, No. 192.
National Guideline Alliance (UK).
Copyright © NICE 2021.

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