Abstract
Objective
This study was undertaken to evaluate the risks and benefits of single-layer uterine
closure at cesarean delivery on the index and subsequent pregnancy.
Study design
A retrospective study of women delivered of their first live-born infants by primary
low transverse cesarean delivery (1989-2001) and their subsequent pregnancy at our
institution was performed.
Results
Of 768 women studied, 267 had single-layer and 501 had double-layer uterine closures
in the index pregnancy. Single-layer closure was associated with slightly decreased
blood loss (646 vs 690 mL, P<.01), operative time (46 vs 52 minutes, P<.001), endometritis (13.5% vs 25.5%, P<.001), and postoperative stay (3.5 vs 4.1 days, P<.001). In the second pregnancy, prior single-layer closure was not associated with
uterine rupture after a trial of labor (0% vs 1.2%, P = .30), or other maternal or infant morbidities. Prior single-layer closure was associated
with increased uterine windows (3.5% vs 0.7%, P = .046) at subsequent cesarean delivery.
Conclusion
Single-layer uterine closure is associated with decreased infectious morbidity in
the index surgery, but not uterine rupture or other adverse outcomes in the subsequent
gestation.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of Obstetrics & GynecologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The technique of cesarean section, with special reference to the lower uterine segment.Am J Obstet Gynecol. 1926; 12: 729-734
- Cesarean section and cesarean hysterectomy.in: Pritchard J.A MacDonald P.C Williams' obstetrics. 15th ed. Appleton-Century-Crofts, New York1976: 903-923
- Comparative study of single layer and conventional closure of uterine incision in cesarean section.Int J Gynecol Obstet. 1988; 27: 349-352
- Transverse uterine incision closure: one versus two layers.Am J Obstet Gynecol. 1992; 167: 1108-1111
- Continuous, nonlocking single-layer repair of the low transverse uterine incision.J Reprod Med. 1993; 38: 393-396
- Is it safe to repair low transverse cesarean section in one layer?.Int J Gynecol Obstet. 1993; 41: 93-95
- Double-layer closure of uterine incision with visceral and parietal peritoneal closure: are they obligatory steps of routine cesarean sections?.J Matern Fetal Med. 1996; 5: 366-369
- One- versus two-layer closure of a low transverse cesarean: the next pregnancy.Obstet Gynecol. 1997; 89: 16-18
- Trial of labor after a one- or two-layer closure of a low transverse uterine incision.Am J Obstet Gynecol. 1993; 168: 545-546
- The impact of a single-layer or double-layer closure on uterine rupture.Am J Obstet Gynecol. 2002; 186: 1326-1330
- The impact of single- or double-layer closure on uterine rupture.Am J Obstet Gynecol. 2003; 188: 295-296
Article Info
Publication History
Cleveland, Ohio
Footnotes
☆Supported in part by a grant from the National Center for Research, MO1-RR-00080.
☆Presented at the Twenty-Third Annual Meeting of the Society for Maternal-Fetal Medicine, San Francisco, Calif, February 3-8, 2003.
☆Reprints not available from the authors.
Identification
Copyright
© 2003 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
