Trial reportBJOG : an international journal of obstetrics and gynaecology2021
Effect of single- versus double-layer uterine closure during caesarean section on postmenstrual spotting (2Close): multicentre, double-blind, randomised controlled superiority trial.
Trial report in BJOG : an international journal of obstetrics and gynaecology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 27 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
27 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche: a systematic review and meta-analysis of randomized trials.Archives of gynecology and obstetrics · 2025Pooled it
- Prevalence of cesarean scar disorder in patients 3 years after a first cesarean section.Acta obstetricia et gynecologica Scandinavica · 2025Trial
- A prospective comparative study of single-layer versus double-layer uterine closure techniques on cesarean scar formation.BMC pregnancy and childbirth · 2025Trial
- Evaluation of single-layer versus double-layer suturing of low transverse uterine incisions in cesarean section and follow-up of scars by ultrasound: a prospective randomized controlled study.Turkish journal of medical sciences · 2024Trial
- Trial
- Effect of single- versus double-layer uterine closure during caesarean section on postmenstrual spotting (2Close): multicentre, double-blind, randomised controlled superiority trial.BJOG : an international journal of obstetrics and gynaecology · 2021Trial
- Patient and public involvement (PPI) reporting in maternal and neonatal clinical trials: an exploratory review.Trials · 2026Review
- Uterine closure after cesarean delivery: surgical technique, biological rationale, and clinical implications.American journal of obstetrics and gynecology · 2026Review
- Uterine closure techniques during cesarean delivery and placenta accreta spectrum incidence in subsequent pregnancies: A systematic review and meta-analysis.Pregnancy (Hoboken, N.J.) · 2026Article
- The diagnosis and management of extrauterine and uterine ectopic pregnancy.Human reproduction update · 2026Review
- Matters arising: single-versus double-layer uterine closure at the time of cesarean delivery and risk of uterine scar niche.Archives of gynecology and obstetrics · 2025Article
- Development of the Er-Kay Classification: A Novel Volume-Based Assessment of Cesarean Scar Defects and Their Association with Abnormal Uterine Bleeding.Journal of clinical medicine · 2025Article
- Ranking of Risk Factors Leading to Uterine Scar Defect-Systematic Online Review.Journal of clinical medicine · 2025Review
- Single- vs double-layer uterine closure of the cesarean scar in niche development: the Nicest Study.AJOG global reports · 2025Article
- Contrast Hysterosonographic Evaluation of Niche Prevalence Following a Standardized Suturing Technique for Caesarean Sections.Geburtshilfe und Frauenheilkunde · 2024Article
- Article
- The degree of risk factor and accumulation effect for large niche in individuals after cesarean section.BMC pregnancy and childbirth · 2024Article
- A transvaginal ultrasound-based diagnostic calculator for uterus post-cesarean scar defect.BMC women's health · 2023Article
- Intra-operative Guidelines for the Prevention of Uterine Niche Formation in Cesarean Sections: A Review.Cureus · 2023Review
- Letter on Genovese et al.'s "Impact of Hysterotomy Closure Technique on Subsequent Cesarean Scar Defects Formation: A Systematic Review".Gynecologic and obstetric investigation · 2023Article
Corrections and comments
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Authors and funding
11 authors at 5 institutions in 3 countries.
Funding
Abstract
objectiveTo evaluate whether double-layer uterine closure after a first caesarean section (CS) is superior compared with single-layer uterine closure in terms of postmenstrual spotting and niche development in the uterine caesarean scar.
designMulticentre, double-blind, randomised controlled superiority trial.
settingThirty-two hospitals in the Netherlands. POPULATION: A total of 2292 women aged ≥18 years undergoing a first CS were randomly assigned to each procedure (1:1): 1144 women were assigned to single-layer uterine closure and 1148 women were assigned to double-layer uterine closure.
methodsSingle-layer unlocked closure and double-layer unlocked closure, with the second layer imbricating the first.
main outcome measuresNumber of days with postmenstrual spotting during one menstrual cycle 9 months after CS. SECONDARY OUTCOMES: perioperative and menstrual characteristics; transvaginal ultrasound measurements.
resultsA total of 774 (67.7%) women from the single-layer group and 770 (67.1%) women from the double-layer group were evaluable for the primary outcome, as a result of drop-out and amenorrhoea. The mean number of postmenstrual spotting days was 1.33 (bootstrapped 95% CI 1.12-1.54) after single-layer closure and 1.26 (bootstrapped 95% CI 1.07-1.45) after double-layer closure (adjusted mean difference -0.07, 95% CI -0.37 to 0.22, P = 0.810). The operative time was 3.9 minutes longer (95% CI 3.0-4.9 minutes, P < 0.001) and niche prevalence was 4.7% higher (95% CI 0.7-8.7%, P = 0.022) after double-layer closure.
conclusionsThe superiority of double-layer closure compared with single-layer closure in terms of postmenstrual spotting after a first CS was not shown. Long-term obstetric follow-up of our trial is needed to assess whether uterine caesarean closure guidelines should be adapted. TWEETABLE ABSTRACT: Double-layer uterine closure is not superior for postmenstrual spotting after a first caesarean; single-layer closure performs slightly better on other outcomes.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.