Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture

• Published in: International journal of gynecology and obstetrics Vol. 115; no. 1; pp. 5 - 10
• Main Authors: Roberge, Stéphanie, Chaillet, Nils, Boutin, Amélie, Moore, Lynne, Jastrow, Nicole, Brassard, Normand, Gauthier, Robert J, Hudic, Igor, Shipp, Thomas D, Weimar, Charlotte H.E, Fatusic, Zlatan, Demers, Suzanne, Bujold, Emmanuel
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01.10.2011; Elsevier
• Subjects: Biological and medical sciences; Cesarean delivery; Cesarean Section - adverse effects; Cesarean Section - methods; Delivery. Postpartum. Lactation; Female; Gynecology. Andrology. Obstetrics; Humans; Hysterotomy; Hysterotomy - adverse effects; Hysterotomy - methods; Medical sciences; Obstetrics and Gynecology; Pregnancy; Risk; Surgical Wound Dehiscence - etiology; Uterine rupture; Uterine Rupture - etiology; Vaginal birth after cesarean; Cesarean delivery; Pregnancy; Hysterotomy; Vaginal birth after cesarean; Uterine rupture; Closure; Gynecology; Rupture; Layer; Double; Obstetrics; Female genital diseases; Incision; Obstetrical technique; Vaginal route; Treatment; Uterus; Surgery; Risk factor; Delivery; Cesarean section; Comparative study
• ISSN: 0020-7292; 1879-3479
• DOI: 10.1016/j.ijgo.2011.04.013

Abstract 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.