Objective:

To evaluate whether a layered precision suturing approach enhances uterine scar healing compared to conventional double-layer closure in cesarean deliveries, focusing on healing outcomes.

Key Findings:

• Inadequate healing was observed in 7.5% of the LP cohort vs. 15.0% in the DL cohort (P = 0.015; risk ratio 0.50, 95% CI 0.28–0.89).
• Mean residual myometrial thickness (RMT) was higher in the LP group (3.05 mm vs. 2.78 mm, P < 0.001; adjusted difference 0.27 mm, 95% CI 0.12–0.42).
• Lower prevalence of uterine niches in the LP group (12 vs. 24, P = 0.043; risk ratio 0.50, 95% CI 0.26–0.98).
• LP group showed higher MRI ADC values (1.18 ± 0.12 vs. 1.12 ± 0.13 × 10⁻³ mm²/s, P = 0.004) and decreased elastography stiffness (28 [24–33] vs. 32 [27–37] kPa, P = 0.001).
• Perioperative outcomes slightly favored LP with less estimated blood loss (480 vs. 520 mL, P = 0.009) and shorter operative duration (42.5 vs. 45.3 min, P < 0.001).

Interpretation:

Layered precision closure with measured tension significantly improved uterine scar healing, highlighting the importance of biomechanics-informed surgical techniques without increasing safety risks.

Limitations:

• Single-center study may limit generalizability.
• Blinding of surgeons was not possible due to the nature of the interventions, which may introduce bias.

Conclusion:

Layered precision suturing enhances uterine scar repair and should be considered over conventional methods in cesarean deliveries.