A recent study has raised important concerns about the long-term safety of current uterine closure techniques used during cesarean deliveries, with a particular focus on the widely used single-layer suturing method. Although this approach is favored for its efficiency and convenience, emerging research suggests that it may carry increased risks for future pregnancies, particularly when compared to the double-layer method.

Historically, the single-layer uterine closure technique has been preferred for its ability to reduce operative time and minimize blood loss. However, as the body of research grows, it has become clear that this technique may have unintended consequences for women in future pregnancies, leading to concerns about its long-term safety.

A key study that raised alarms regarding the single-layer closure method was published in 2017 by Vachon-Marceau et al. in the American Journal of Obstetrics and Gynecology. Their findings indicated that single-layer uterine closure was associated with a higher risk of uterine rupture compared to the double-layer method. This finding particularly concerns women who are planning future pregnancies or those who are considering attempting a vaginal birth after cesarean (VBAC). The study highlighted that, while the single-layer method may offer certain short-term advantages, the risks of uterine rupture in subsequent pregnancies cannot be ignored.

However, more recent research has provided additional perspectives on the subject. The 2Close Trial, a large multicenter randomized study published in 2024 by Verberkt et al., followed 2,292 women for three years. The trial found no significant difference in major outcomes between the single-layer and double-layer closure techniques. Key metrics, such as pregnancy rates, delivery modes, and rates of uterine rupture, were found to be similar between the two groups. This finding suggests that while single-layer closure may not universally pose higher risks, the evidence is still evolving, and patient-specific factors should always be considered when choosing the appropriate method.

Despite the findings of the 2Close Trial, other systematic reviews and meta-analyses have provided mixed results. Some studies show that single-layer uterine closures may lead to thinner residual uterine walls and an increased incidence of scar defects, such as niches, which are areas of weakened tissue that can affect the function of the uterus in subsequent pregnancies. On the other hand, other studies have found minimal differences in both short-term and long-term outcomes between the two closure techniques.

The overall risk of uterine rupture remains low, and long-term comparative data is still developing, which means that there is no universally accepted guideline on which closure method is superior. The decision between single-layer and double-layer closure is often left to the surgeon’s discretion, influenced by factors such as institutional policies, the patient’s individual health circumstances, and whether the patient plans to have future pregnancies.

The evolving body of evidence surrounding uterine closure methods underscores the need for informed consent and individualized care. As research continues to develop, it is crucial that patients are made aware of the potential risks and benefits of each technique, with a focus on their long-term reproductive health. Healthcare providers must ensure that women are fully informed about their options and involved in the decision-making process to ensure that the closure technique chosen aligns with their future reproductive goals.

The ongoing debate about uterine closure techniques highlights the importance of research and evidence-based practices in improving outcomes for women undergoing cesarean deliveries. As more studies are conducted and long-term data accumulates, the understanding of how these techniques impact maternal health will continue to evolve, ultimately leading to more tailored and safer approaches for women in their reproductive years.