title: The role of uterine closure in the risk of uterine rupture.
abstract: 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.
authors.affiliation: 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.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
authors.forename: Martine
authors.initials: M
authors.lastname: Goyet
authors.forename: Sylvie
authors.initials: S
authors.lastname: Marcoux
authors.forename: Normand
authors.initials: N
authors.lastname: Brassard
authors.forename: Béatrice
authors.initials: B
authors.lastname: Cormier
authors.forename: Emily
authors.initials: E
authors.lastname: Hamilton
authors.forename: Belkacem
authors.initials: B
authors.lastname: Abdous
authors.forename: Elhadji A Laouan
authors.initials: EAL
authors.lastname: Sidi
authors.forename: Robert
authors.initials: R
authors.lastname: Kinch
authors.forename: Louise
authors.initials: L
authors.lastname: Miner
authors.forename: André
authors.initials: A
authors.lastname: Masse
authors.forename: Claude
authors.initials: C
authors.lastname: Fortin
authors.forename: Guy-Paul
authors.initials: GP
authors.lastname: Gagné
authors.forename: André
authors.initials: A
authors.lastname: Fortier
authors.forename: Gilles
authors.initials: G
authors.lastname: Bastien
authors.forename: Robert
authors.initials: R
authors.lastname: Sabbah
authors.forename: Pierre
authors.initials: P
authors.lastname: Guimond
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Roberge
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gauthier
mesh_terms: 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*