Incomplete healing after cesarean section (CS) can result in isthmocele formation. When suturing the uterus, fully folding the wound lips may embed the endometrial layer into the myometrium, leading to isthmocele development. Hence, this study aimed to compare the effects of endometrial and non-endometrial suturing on isthmocele development. This randomized controlled trial included 274 patients. Women who underwent primary CS were randomly allocated to one of the two study groups: endometrial suturing and non-endometrial suturing. The primary outcome was isthmocele rate at postpartum 6 months. Secondary outcomes were the volume of the isthmocele, thickness of the residual myometrium, menstrual irregularities (intermenstrual spotting), and the relationship between the isthmocele and uterine position. A total of 159 patients (81 in the endometrial suturing group and 78 in the non-endometrial suturing group) were analyzed. The incidence of isthmocele was significantly lower in the non-endometrial suturing group than in the endometrial suturing group (12 [15.4%] vs. 24 [29.6%] patients; = 0.032). Menstrual irregularities, such as intermenstrual spotting, were significantly higher in the endometrial suturing group than in the non-endometrial group ( = 0.019). Uterine closure with non-endometrial suturing was associated with significantly lower isthmocele development and less intermenstrual spotting compared to that with endometrial suturing.

中文翻译：

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子宫内膜与非子宫内膜缝合对峡部膨出发育的影响；一项随机对照试验。

剖宫产 (CS) 后不完全愈合可导致峡部膨出形成。缝合子宫时，完全折叠伤口唇可能会将子宫内膜层嵌入子宫肌层，导致峡部膨出。因此，本研究旨在比较子宫内膜和非子宫内膜缝合对峡部膨出发育的影响。这项随机对照试验纳入了 274 名患者。接受初次 CS 的女性被随机分配到两个研究组之一：子宫内膜缝合组和非子宫内膜缝合组。主要结局是产后 6 个月的峡部膨出发生率。次要结果是峡部膨出的体积、残余子宫肌层的厚度、月经不规则（月经间期点滴出血）以及峡部膨出和子宫位置之间的关系。共有 159 例患者（子宫内膜缝合组 81 例，非子宫内膜缝合组 78 例）进行了分析。非子宫内膜缝合组峡部膨出的发生率显着低于子宫内膜缝合组（12 例 [15.4%] 比 24 例 [29.6%] 患者；= 0.032）。子宫内膜缝合组的月经不规律（例如经间期点滴出血）显着高于非子宫内膜组（= 0.019）。与子宫内膜缝合相比，非子宫内膜缝合的子宫闭合与峡部膨出显着降低和经间期点状出血减少相关。