Surgery Techniques
Six operators performed the CD operations. Access to the abdomen was achieved via Pfannenstiel incision, while the Kerr incision technique was applied to the uterus for all patients. Patients in the single-layer group received uterus closures with locking, while patients in the double-layer group received uterus closures with locking in the first layer, but without locking and using a parallel Lembert-type imbricating stitch in the second layer. The decidua was deliberately excluded during all suturations. A synthetic absorbable suture material (Vicryl 1.0, Ethicon, Somerville, NJ, USA) was used during all uterus closures, with corner stitches applied to all patients. Additional suture usages and numbers were reported only in cases of bleeding. Both uterine closure and whole operation times were recorded by the respective operating room technicians. Finally, intravenous prophylactic antibiotics (2 g cefazolin sodium) and uterotonic medications (10 IU oxytocin) were routinely applied during all CD procedures.