Medline ® Abstract for Reference 54
of 'Cesarean delivery: Surgical technique'
Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture.
Roberge S, Chaillet N, Boutin A, Moore L, Jastrow N, Brassard N, Gauthier RJ, Hudic I, Shipp TD, Weimar CH, Fatusic Z, Demers S, Bujold E
Int J Gynaecol Obstet. 2011 Oct;115(1):5-10. Epub 2011 Jul 26.
OBJECTIVE: To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture.
METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model.
RESULTS: Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI]0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure.
CONCLUSION: Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.
Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitéLaval, Quebec, Canada.