title: Transverse uterine incision closure: one versus two layers.
abstract: OBJECTIVE
  Closure of a low transverse cesarean incision with one layer of suture results in less operating time, better hemostasis, and less infectious morbidity than a two-layer closure.
  
  
  METHODS
  At our institution 906 women were randomized to closure of a low transverse cesarean incision with either one continuous layer of a locking No. 1 chromic suture and a CTX needle (n = 457) or two continuous layers of No. 1 chromic suture with the first layer locked (n = 449). The Student t test, chi 2 test of proportion, and Wilcoxon rank sum test were used to compare groups of patients.
  
  
  RESULTS
  A one-layer closure required less operative time, 43.8 versus 47.5 minutes (p = 0.0003). Fewer additional uterine hemostatic sutures were required in 369 women in whom either the one- (n = 179) or the two-layer (n = 190) closure did not achieve hemostasis (p = 0.046). Endometritis was similar in both groups, 83 (22%) in the one-layer group versus 65 (18%) in the two-layer group (p = 0.17). In no outcome assessment was the two-layer closure superior to the one-layer closure.
  
  
  CONCLUSIONS
  We recommend a one-layer closure when its use is anatomically feasible.
authors.affiliation: Department of Obstetrics and Gynecology, University of Alabama, Birmingham 35233-7333.
authors.forename: J C
authors.initials: JC
authors.lastname: Hauth
authors.forename: J
authors.initials: J
authors.lastname: Owen
authors.forename: R O
authors.initials: RO
authors.lastname: Davis
mesh_terms: D000328:Adult; D002585:Cesarean Section; D004716:Endometritis / Q000209:etiology; D005069:Evaluation Studies as Topic; D005260:Female; D006489:Hemostatic Techniques; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy; D013530:Surgical Wound Infection; D013536:Suture Techniques