RESULTS
A total of 282 patients met the initial inclusion criteria for this study. Of these, 57 were excluded (20.2%); 49 were lost to follow-up (17.4%), six became pregnant (2.1%), and two could not endure ultrasonography due to intolerances to pelvic examinations (0.71%). Thus, 225 patients were fully evaluated. Niche assessment was evaluated via SIS in 221 patients, while TV USG was used for four patients due to the use of intrauterine devices or intolerance to SIS. Of the 225 total remaining participants, 109 were placed into the single-layer treatment group, while 116 were placed into the double-layer treatment group (Figure 1). Further, 165 (73.3%) patients reported that menstruation had begun when they returned for checkups 6-9 months after CS.
Participants of both treatment groups were compared based on their maternal and obstetric characteristics as well as those related to CD operations. Except for shorter uterine closures and operation durations for single-layer closures, all factors were similar between groups (Table 1).
The CD indications were fetal presentation anomalies (n=36, 16%), fetal distress (n=25, 11.1%), discontinued labor (n=31, 13.8%), maternal request (n=57, 25.3%), cephalo-pelvic disproportion (n=47, 20.9%), and reasons such as severe preeclampsia, maternal factors, fetal anomalies, and placenta anomalies (n=29, 12.9%).
This study found that niche rates and mean depths for the TV USG and SIS patients were 21%, 0.9±1.8mm and 41%, 2.1±1.9mm, respectively (p<0.001, p<0.001). Niche positivity was determined for 93 patients, while more frequent PMB and dysmenorrhea were observed among patients for whom niches were determined (32.1% vs 5.2%; p<0.001, 12.9% vs 4.6%; p=0.043). Niche shapes were triangular (82%), oval (10.1%), circular (4.5%), square (2.2%), and totally defective (%1.1), while niche rates were 37% for the single-layer group and 45.7% for the double-layer group (p=0.22). No significant differences were found between the niche depth measurements used to define niche presence (p=0.10), nor were any significant differences found in niche width measurements (p=0.07). However, niche width was higher in the transvers plane among participants of the double-layer group when compared to those in the single-layer group (p=0.006) (Table 2). On the other hand, no significant intergroup differences were found in terms of RMT, AMT, healing ratio values, and PMB / dysmenorrhea symptoms (Table 2). Mean uterine closures and operation durations were shorter among the single-layer group (p<0.001, p=0.001).