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Single-layer closure may raise rupture risk later.
MIAMI BEACH -- Single-layer closure from a prior cesarean delivery increases risk of symptomatic uterine rupture in a subsequent trial of labor, compared with double-layer closure, Dr. Martine Goyet said at the annual meeting of the Society for Maternal-Fetal Medicine.
Dr. Goyet and his colleagues conducted a multicenter, case-control study to compare the two closure techniques. They reviewed records from 1993 to 2003 for nine maternity wards.
"Single-layer closure was the only significant negative factor associated with uterine rupture in a multivariate analysis [odds ratio 2.31]," said Dr. Goyet of the department of obstetrics and gynecology, Hopital Sainte-Justine, Montreal.
"Prior vaginal delivery was the only positive significant factor [odds ratio 0.49]."
They identified 96 cases of symptomatic uterine rupture, including emergency laparotomy, using ICD-9 codes and perinatal databases. They also identified three matched controls for each case. The controls were women who underwent a trial of labor before each uterine rupture case; the control group totaled 288. Maternal age and parity did not significantly differ between groups.
Cases had a history of one low transverse cesarean delivery and uterine rupture with an attempted trial of labor. The researchers excluded women with a history of more than one cesarean delivery, prior ...
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