– Routine manual/instrumental cervical dilatation before closing the uterus is unnecessary in both laboring and non-laboring women.
– Do not irrigate the uterus with antibiotic solution before closure.
– Choice of suture is largely based on personal preference.
– Myometrial closure: perform a 2-layer, continuous closure with delayed absorbable synthetic suture incorporating all of the muscle to avoid bleeding from the incision edges.
– We do not use locking sutures unless arterial bleeding is evident.
– The endometrial layer should probably be included in the full thickness myometrial closure.
– Perform a 2-layer rather than a single-layer uterine closure, but use a single-layer closure when a tubal ligation is performed concurrently. If a single-layer closure is performed to save time, we suggest an unlocked technique. A double (or even triple)- layer closure may be necessary when the myometrium is thick, such as with a classical incisions.
– Do not close the visceral or parietal peritoneum because it saves time and there is no convincing evidence of harm (increased adhesion formation).