Double-layer closure is better during C/S

Reporting findings that may change current practice, Canadian researchers at the annual SMFM meeting have concluded that two-layer closures during cesarean deliveries are safer than the single-layer closures that have been so widely adapted. In one of the largest series of symptomatic uterine ruptures, University of Montreal investigators found previous locked single-layer closure to be independently associated with uterine rupture.

They performed a multicenter case–control study of women who'd had a single prior low-transverse cesarean (LTCS) who subsequently had a symptomatic uterine rupture during a trial of labor (TOL). Reviewing cases from 1993 to 2003, the researchers included as controls three women who'd undergone a TOL without rupture after a previous LTCS for every case of rupture. The two groups were compared for risk factors like type of prior closure (single or double layer), prior cephalopelvic disproportion (CPD), diabetes, type of suture, labor induction, birthweight, cervical ripening, and prior vaginal delivery.

Studying 96 cases of women with uterine ruptures and 288 controls, they found that patients with ruptured uteri were more likely to have had single-layer closure (36.5% vs. 20.1%), interdelivery interval of less than 24 months, labor induction with unfavorable uterus, gestational age of 41 weeks, birthweight of 4,000 g, and no prior vaginal delivery. Their analysis revealed that type of suture, maternal weight and age, prior CPD, prostaglandins, and diabetes could not be correlated with uterine rupture. Even after controlling for confounding factors, four risk factors did remain linked with rupture: single-layer closure (OR 2.31, 95% CI; 1.28–4.16), prior vaginal delivery, induction of labor with unfavorable cervix, and macrosomia.