title: Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture.
abstract: OBJECTIVE
  To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture.
  
  
  METHODS
  The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model.
  
  
  RESULTS
  Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure.
  
  
  CONCLUSIONS
  Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.
authors.affiliation: Department of Obstetrics and Gynecology, Faculty of Medicine, Université Laval, Quebec, Canada.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Roberge
authors.forename: Nils
authors.initials: N
authors.lastname: Chaillet
authors.forename: Amélie
authors.initials: A
authors.lastname: Boutin
authors.forename: Lynne
authors.initials: L
authors.lastname: Moore
authors.forename: Nicole
authors.initials: N
authors.lastname: Jastrow
authors.forename: Normand
authors.initials: N
authors.lastname: Brassard
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gauthier
authors.forename: Igor
authors.initials: I
authors.lastname: Hudic
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Shipp
authors.forename: Charlotte H E
authors.initials: CH
authors.lastname: Weimar
authors.forename: Zlatan
authors.initials: Z
authors.lastname: Fatusic
authors.forename: Suzanne
authors.initials: S
authors.lastname: Demers
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Bujold
mesh_terms: D002585:Cesarean Section / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D020883:Hysterotomy / Q000009:adverse effects / Q000379:methods*; D011247:Pregnancy; D012306:Risk; D013529:Surgical Wound Dehiscence / Q000209:etiology; D014597:Uterine Rupture / Q000209:etiology*