Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture (original) (raw)
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Impact single versus double layer uterine closure in caesarean section to uterine rupture
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
There have been only 1 systematic review and 3 studies conducted to know the impact of single versus double layer uterine closure to uterine rupture. 7-10 However, there is still no formal publication about evidence-based case report (EBCR) discussing about this topic. Therefore, we do this analysis to solve the question which often arises during our practice.
Ultrasound in Obstetrics & Gynecology, 2016
Objective To investigate short-and long-term effects on residual myometrial thickness (RMT) of adding a second layer to a single unlocked closure of a Cesarean uterine incision. Methods This was a randomized double-blind controlled trial. Healthy nulliparous women scheduled for first-time elective Cesarean delivery were operated on using a modified version of the Misgav Ladach surgical technique. The women were examined by transabdominal ultrasound before discharge from the maternity ward and by transvaginal saline contrast sonohysterography at a minimum of 5 months postpartum. Results Seventy-six nulliparae met the criteria and agreed to participate in the study. Thirty-five women were assigned to the single-layer technique and 38 to the double-layer unlocked closure technique. Groups were comparable regarding gestational age at delivery, duration of surgery and perioperative blood loss. There was no difference in RMT between the two groups, both at time of discharge (mean ± SD, 20.2 ± 8.0 mm vs 21.0 ± 9.7 mm) and after 5 months postpartum (mean, 5.7 ± 2.9 mm vs 5.7 ± 2.2 mm). RMT was approximately half that of the normal myometrium at both examinations. Conclusion The results of this study suggest that double-layer closure of a Cesarean uterine incision does not increase RMT compared with single-layer closure when an unlocked technique is used.
OBJECTIVE: A growing body of evidence suggests that the surgical technique for uterine closure influences uterine scar healing, but there is still no consensus about optimal uterine closure during cesarean delivery (CD). The aim of this systematic review and meta-analysis was to compare the effect of single- versus double-layer closure on the risk of uterine scar defect. METHODS: MEDLINE, Scopus, http://ClinicalTrials.gov, the PROSPERO International Prospective Register of Systematic Reviews, EMBASE and the Cochrane Central Register of Controlled Trials were searched from inception of each database until May 2016. All randomized controlled trials (RCTs) evaluating the effect of single- versus double-layer closure at the time of low transverse cesarean on the risk of uterine scar defect were included. The primary outcome was the incidence of uterine scar defects detected on ultrasound. Secondary outcomes were residual myometrial thickness in mm, evaluated by ultrasound, and incidences of uterine dehiscence and uterine rupture at subsequent pregnancy. The summary measures were reported as relative risk (RR) or as mean differences (MD) with 95% confidence interval (CI). For this review the quality of the evidence was assessed using the GRADE approach. RESULTS: Nine RCTs (3,696 participants) were included in the meta-analysis. The overall risk of bias of the included trials was low. Statistically heterogeneity within the studies was low with no inconsistency in the primary and secondary outcomes. Women who received single-layer closure had a similar incidence of uterine scar defects (25.5% vs 43.0%; RR 0.77, 95% CI 0.36 to 1.64; 5 trials; 350 participants; low-quality of evidence) compared to women who received double-layer closure. Women who received single-layer closure had a significantly thinner residual myometrial thickness on ultrasound compared to double-layer closure (MD -2.19 mm, 95% CI -2.80 to -1.57; 4 trials; 374 participants; low-quality of evidence). No differences were found in incidence of uterine dehiscence (0.4% vs 0.2%; RR 1.34, 95% CI 0.24 to 4.82; 3 trials; 3,421 participants; low-quality of evidence) or uterine rupture in the subsequent pregnancy (0.1% vs 0.1%; RR 0.52, 95% CI 0.05 to 5.53; 1 trial; 3,234 participants; low-quality of evidence). CONCLUSIONS: Single- and double-layer closure of a cesarean uterine incision are associated with similar incidences of uterine scar defect, as well as incidences of uterine dehiscence and uterine rupture in a subsequent pregnancy.
Risk of Uterine Rupture Following Locked Vs Unlocked Single-layer Closure
Medical Archives, 2012
O bjective: To compare the rate of uterine scar disruption after a locked versus an unlocked single-layer closure of the hysterotomy incision at a previous cesarean. Methods: A retrospective cohort study in a population where both locked and unlocked single-layer closure are commonly used. All singleton pregnancies at 24 weeks' gestation or more with a previous single cesarean were included. Rate of uterine scar disruption (complete uterine rupture and uterine scar dehiscence) were compared between women with a previous locked and those with a previous unlocked single-layer closure of the uterus. Results: Out of 388 women included in the study, 272 had a previous unlocked single-layer closure and 116 had a locked single-layer closure. We found no significant difference in the rate of uterine scar disruption between the two groups (5.9% vs 8.6%, p=0.32). Conclusion: Locking a single-layer closure was not associated with an increase rate of uterine scar disruption at the next pregnancy in our retrospective analysis. A randomized trial should be performed.
International Archives of BioMedical and Clinical Research
Background: Suturing of caesarean incision leads to reduction in maternal mortality, suturing can be done in either single layer or double layer. Many studies have shown both of them to be effective, with no conclusive evidence of preference of any one of them. The objective of this study was to compare method of uterine closure by single-layer and double-layer closure keeping in mind the intraoperative and postoperative morbidity in index pregnancy and risk of uterine rupture in future pregnancy. Methods: This prospective randomized controlled study was done from March 2007 to January 2009, a total of 357 women were enrolled for lower segment caesarean section either to single layer (n=188) or double layer (n=169) closure of uterine incision. Primary outcome measures studied were operating time, intraoperative blood loss, and febrile morbidity in index pregnancy and chances of uterine rupture in subsequent pregnancy. Secondary outcome measures were cystitis, wound infection and hospital stay. Results were compared by Chi-square test. Results: Patients with single layer closure had significantly (p<0.05) less operative time and estimated blood loss as compared to double layer closure. There was also a statistically significant (p<0.05) difference in febrile morbidity and hospital stay in single layer closure of uterus. There was however no significant difference in other variables also, in subsequent pregnancy with previous caesarean section there was no difference in pregnancy outcome in both groups was not statistically significant (p-value>0.05). Operative findings in subsequent pregnancy don't differ much. Conclusions: Single layer closure was associated with lesser operating time, intra-operative blood loss, febrile morbidity and hospital stay in index pregnancy as compared to double-layer closure.
Analysis of Impact of Single Layer Uterine Closure at Repeat Cesarean Section
Objective: To study effectiveness of single layer lower uterine segment closure in repeat caesarean cases in terms of scar dehiscence, intra operative complications such as adhesion, advanced bladder and adhesion at the time of next caesarean section. Aim: To analyse the impact of single layerlower uterine segment uterine closure at repeat cesarean section cases. Method: A Retrospective analysis of 70 cases undergoing repeat cesarean section who had primary cesarean with single layer lower uterine segment closure in Department of OBG at Dr B R Ambedkar medical college and hospital. Intra operative difficulties and post operative complication were noted. Data was collected and analysed using computer software. Results: A total of 70 cases was analysed who had single layer uterine closure there were 8 case of advanced bladder, Thinned out lower uterine segment in 14 cases , 2 underwent uterine artery ligation,2 had scar dehiscence and in 16 cases adhesions were noted. Among them 28 had Emergency caesarean deliveries and 42 were taken up for Elective section. Conclusion: Single layer uterine closure is as effective as double layer sutures as it is faster, equally effective as double layer closure, shortens operative time, minimise usage of suture material, reduces infection rate, decreased bood loss, lower rate of endometritis and shortens hospital stay
American journal of obstetrics and gynecology, 2017
Uterine rupture is a potential life-threatening complication during a trial of labor after cesarean delivery. Single-layer closure of the uterus at cesarean delivery has been associated with an increased risk of uterine rupture compared with double-layer closure. Lower uterine segment thickness measurement by ultrasound has been used to evaluate the quality of the uterine scar after cesarean delivery and is associated with the risk of uterine rupture. To estimate the impact of previous uterine closure on lower uterine segment thickness. Women with a previous single low-transverse cesarean delivery were recruited at 34-38 weeks' gestation. Transabdominal and transvaginal ultrasound evaluation of the lower uterine segment thickness was performed by a sonographer blinded to clinical data. Previous operative reports were reviewed to obtain the type of previous uterine closure. Third-trimester lower uterine segment thickness at the next pregnancy was compared according to the number ...
Archives of Gynecology and Obstetrics, 2018
Background We aimed to determine if there is a difference in the size of the cesarean scar defect using saline infusion sonography (SIS) performed on the postoperative third month in patients who underwent single-or double-layered unlocked closure of their uterine incision during their first cesarean delivery. Methods This study was conducted as a prospective cross-sectional study between February 2015 and January 2016 in patients admitted to the labour ward of the Kanuni Sultan Suleyman Training and Research Hospital who subsequently underwent their first delivery by cesarean section. Patients with a previous history of cesarean delivery, preterm pregnancies less than 34 gestational weeks, patients lost to follow-up or those who had an IUD inserted after delivery were excluded from the study. Out of the 327 patients who underwent primary cesarean delivery, 280 were included into the study. Patients were divided into two groups according to the single-(n:126) or double-layered (n:156) closure of their uterine incision. The maternal age, height, weight, obstetric and gynecologic histories, medical histories, indications for their cesarean delivery, technique of uterine closure, birth weight of the baby, duration of the cesarean delivery, need for extra suturing and transfusion were recorded. A Saline infusion sonography (SIS) was performed 3 months postoperatively to determine the presence, depth and length of the cesarean scar. The residual myometrial thickness overlying the scar defect and the fundal myometrial thickness were recorded. Results No difference was detected between the groups with respect to patient characteristics, whether the operation was elective or emergent, the type of anesthesia used, need for extra suturing, incidence of bladder injuries or uterine atony, need for blood transfusions, duration of labour or cervical dilatation and effacement between the two groups. No statistically significant difference was detected between the two groups with respect to the length and depth of the scar defect. Conclusion Single-or double-layered closure of the uterus does not seem to affect the size of the uterine scar defect detected on SIS 3 months following the first cesarean delivery.