Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery: A Systematic Review and...

Area of Science:

• Obstetrics and Gynecology
• Surgical Innovation
• Evidence-Based Medicine

Background:

• Cesarean delivery is a common surgical procedure.
• Uterine closure techniques during cesarean delivery are debated.
• Potential complications include uterine scar defects and menstrual irregularities.

Purpose of the Study:

• To meta-analyze randomized trials on endometrial closure during cesarean delivery.
• To assess the impact of endometrial closure on uterine scar defects and menstrual symptoms.
• To evaluate surgical morbidity associated with different closure methods.

Main Methods:

• Systematic search of Medline, EMBASE, Cochrane Library, and ClinicalTrials.gov.
• Inclusion of randomized controlled trials (RCTs) and quasi-RCTs comparing endometrial closure versus no closure.
• Meta-analysis using random-effects models and GRADE approach for evidence certainty.

Main Results:

• Not closing the endometrium reduced intermenstrual bleeding (RR 0.34) and uterine scar defects (RR 0.53) with high-certainty evidence.
• No significant differences were observed in heavy uterine bleeding, dysmenorrhea, pelvic pain, or endometritis.
• Analysis included six RCTs involving 491 women.

Conclusions:

• Omitting endometrial closure during cesarean delivery is associated with reduced intermenstrual bleeding.
• Non-closure of the endometrium also decreases the risk of uterine scar defects.
• This approach may simplify cesarean delivery with favorable outcomes.