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Medline ® Abstract for Reference 54

of 'Cesarean delivery: Surgical technique'

54
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Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture.
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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
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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.
AD
Department of Obstetrics and Gynecology, Faculty of Medicine, UniversitéLaval, Quebec, Canada.
PMID