title: The risk of uterine rupture is not increased with single- compared with double-layer closure: a Swedish cohort study.
abstract: OBJECTIVE
  To compare single- with double-layer closure of the uterus for the risk of uterine rupture in women attempting vaginal birth after one prior caesarean delivery.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Sweden.
  
  
  METHODS
  From a total of 19 604 nulliparous women delivered by caesarean section in the years 2001-2007, 7683 women attempting vaginal birth in their second delivery were analysed.
  
  
  METHODS
  Data from population-based registers were linked to hospital-based registers that held data from maternity and delivery records. Logistic regression was used to estimate the risk of uterine rupture after single- or double-layer closure of the uterus. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).
  
  
  METHODS
  Uterine rupture.
  
  
  RESULTS
  Uterine rupture during labour occurred in 103 (1.3%) women. There was no increased risk of uterine rupture when single- was compared with double-layer closure of the uterus (OR 1.17; 95% CI 0.78-1.76). Maternal factors associated with uterine rupture were: age ≥35 years and height ≤160 cm. Factors from the first delivery associated with uterine rupture in a subsequent delivery were: infection and giving birth to an infant large for gestational age. Risk factors from the second delivery were induction of labour, use of epidural analgesia, and a birthweight of ≥4500 g.
  
  
  CONCLUSIONS
  There was no significant difference in the rate of uterine rupture when single-layer closure was compared with double -layer closure of the uterus.
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.|Center for Clinical Research, Dalarna, Falun, Sweden.
authors.forename: S
authors.initials: S
authors.lastname: Hesselman
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: U
authors.initials: U
authors.lastname: Högberg
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Ekholm-Selling
authors.affiliation: Center for Clinical Research, Dalarna, Falun, Sweden.
authors.forename: E-B
authors.initials: EB
authors.lastname: Råssjö
authors.affiliation: Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Jonsson
mesh_terms: D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D001724:Birth Weight; D001827:Body Height; D015331:Cohort Studies; D016640:Diabetes, Gestational / Q000453:epidemiology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced; D007743:Labor, Obstetric; D008423:Maternal Age; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology; D012042:Registries; D012306:Risk; D012307:Risk Factors; D013536:Suture Techniques; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D014597:Uterine Rupture / Q000453:epidemiology*; D014599:Uterus / Q000601:surgery*; D016064:Vaginal Birth after Cesarean
keywords: Uterine closure; uterine rupture; vaginal birth after caesarean section