The role of uterine closure in the risk of uterine rupture.
OBJECTIVE
To evaluate the effects of prior single-layer compared with double-layer closure on the risk of uterine rupture.


METHODS
A multicenter, case-control study was performed on women with a single, prior, low-transverse cesarean who experienced complete uterine rupture during a trial of labor. For each case, three women who underwent a trial of labor without uterine rupture after a prior low-transverse cesarean delivery were selected as control participants. Risk factors such as prior uterine closure, suture material, diabetes, prior vaginal delivery, labor induction, cervical ripening, birth weight, prostaglandin use, maternal age, gestational age, and interdelivery interval were compared between groups. Conditional logistic regression analyses were conducted.


RESULTS
Ninety-six cases of uterine rupture, including 28 with adverse neonatal outcome, and 288 control participants were assessed. The rate of single-layer closure was 36% (35 of 96) in the case group and 20% (58 of 288) in the control group (P<.01). In multivariable analysis, single-layer closure (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.37-5.28) and birth weight greater than 3,500 g (OR 2.03; 95% CI 1.21-3.38) were linked with increased rates of uterine rupture, whereas prior vaginal birth was a protective factor (OR 0.47; 95% CI 0.24-0.93). Single-layer closure was also related to uterine rupture associated with adverse neonatal outcome (OR 2.89; 95% CI 1.01-8.27).


CONCLUSIONS
Prior single-layer closure carries more than twice the risk of uterine rupture compared with double-layer closure. Single-layer closure should be avoided in women who could contemplate future vaginal birth after cesarean delivery.


METHODS
II.
Bujold
Emmanuel
E
From the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada, the Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada, and the Department of Obstetrics & Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec Canada, and the Department of Obstetrics & Gynaecology, Hôpital Lasalle, Lasalle, Quebec, Canada; the Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada, and the Department of Obstetrics & Gynaecology, Faculty of Medicine, St Mary's Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Royal Victoria Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Royal Victoria Hospital, McGill University, Montréal, Quebec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Royal Victoria Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Jewish General Hospital, McGill University, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier de l'Université de Montréal (CHUM), Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Lasalle, Lasalle, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Lasalle, Lasalle, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Pierre-Boucher, Longueuil, Quebec, Canada; the Department of Obstetrics & Gynaecology, Centre Hospitalier Cité de la Santé, Laval, Quebec, Canada; Department of Obstetrics & Gynaecology, Hôpital Sacré-Coeur, Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Hôpital Maisonneuve-Rosemont, Université de Montréal, Montréal, Quebec, Canada; the Department of Obstetrics & Gynaecology, Faculty of Medicine, Centre Hospitalier Universitaire de Québec, Université Laval, Québec, Canada, and the Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada; and the Department of Obstetrics & Gynaecology, Faculty of Medicine, Hôpital Sainte-Justine, Université de Montréal, Montréal, Quebec, Canada.
Goyet
Martine
M
Marcoux
Sylvie
S
Brassard
Normand
N
Cormier
Béatrice
B
Hamilton
Emily
E
Abdous
Belkacem
B
Sidi
Elhadji A Laouan
EAL
Kinch
Robert
R
Miner
Louise
L
Masse
André
A
Fortin
Claude
C
Gagné
Guy-Paul
GP
Fortier
André
A
Bastien
Gilles
G
Sabbah
Robert
R
Guimond
Pierre
P
Roberge
Stéphanie
S
Gauthier
Robert J
RJ
D001724:Birth Weight; D016022:Case-Control Studies; D002585:Cesarean Section / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D013513:Obstetric Surgical Procedures / Q000379:methods; D010298:Parity; D011247:Pregnancy; D014597:Uterine Rupture / Q000209:etiology*; D014599:Uterus / Q000601:surgery*