Single Layer Versus Double Layer Closure of Uterus during Caesarean Section - A Prospective Study in Index and Subsequent Pregnancy
DOI:
https://doi.org/10.21276/dq0ytn06Keywords:
Single layer closure, double layer closure, caesarean section, morbidity, uterine incisionAbstract
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.
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Tully L, Gates S, Brocklehurst P et al. Surgical techniques used during cesarean section operations: results of a national survey of practice in the UK. Eur J Obstet Gynecol Reprod Biol 2002;102:120-6.
Sood Atul Kumar. Single versus double layer closure of low transverse uterine incision at cesarean section. J Obstet Gynecol India 2005;55:231-6.
Bejold E, Bejold C, Hamilton EF, Harel F, Gauthier RJ. The impact of a single layer or double layer closure on uterine rupture. Am J Obstet Gynecol. 2002; 186:1326-30
Gyamfi C, Juhasz G, Gyamfi P, Blumenfeld Y, Stone JL. Single versus double layer uterine incision closure and uterine rupture. J Matern Fetal Neonatal Med 2006;19:639-43.
Hauth JC, Owen J, Davis RO. Transverse uterine incision closure: one versus two layers. Am J Obstet Gynecol 1992 167:1108-11.
Jelsema RD, Wittingen JA, van der Kolk KJ. Continuous, nonlocking, single-layer repair of the low transverse uterine incision. J Reprod 1993;38:393-6.
Iankov M. Single-layer or double-layer suturing of the uterine incision in cesarean section? Akush Ginekol (Sofiia) 1999;38:10-3.
Hohlagschwandtner M, Chalubinski K, Nather A, et al. Continuous vs. interrupted sutures for single-layer closure of uterine incision at cesarean section. Arch Gynecol Obstet 2003;268:26-8.
Popov I, Stoikov S, Bakurdzhiev G et al. A single-stage 2-layer suture in cesarean section-the effect of the surgical technic on postoperative febrile conditions. Akush Ginekol (Sofiia) 1994;33:13-5.
Heidenreich W, Bruggenjurgen K. Modified Sarafoff suture for single layer closure of uterotomy in cesarean section. A prospective study. Zentralbl Gynakol 1995;117:40-4.
Tischendorf D. The single-layer uterine suture in cesarean section. A comparative study. Geburtshilfe Frauenheilkd 1987;47:117-20.
Durnwald C, Mercer B. Uterine rupture, perioperative and perinatal morbidity after single-layer and double-layer closure at cesarean delivery. Am J Obstet Gynecol 2003;189:925-9.
Lal K, Tsomo P. Comparative study of single layer and conventional closure of uterine incision in cesarean section. Int J Gynecol Obstet 1988;27:349-52.
Chapman SJ, Owen J, Hauth JC. One- versus two-layer closure of a low transverse cesarean: the next pregnancy. Obstet Gynecol 1997;89:16-8.
Roberge S, Chaillet N, Boutin A et al: Single versus double layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture. Int J Gynaecol Obstet 2011;115(1):5.
Roberge S, Demers S, Berghella V et al: Impact of single vs. double layer closure on adverse outcomes and uterine scar defect: a systematic review and metaanalysis.Am J Obstet Gynecol 2014;211:453-60.
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