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. CONCLUSION: Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.
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. CONCLUSION: 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: Salvatore Giovanni Vitale; Ilaria Marilli; Pietro Cignini; Francesco Padula; Laura D'Emidio; Lucia Mangiafico; Agnese Maria Chiara Rapisarda; Ferdinando Antonio Gulino; Stefano Cianci; Antonio Biondi; Claudio Giorlandino Journal: J Prenat Med Date: 2014 Apr-Jun
Authors: E Abalos; V Addo; P Brocklehurst; M El Sheikh; B Farrell; S Gray; P Hardy; E Juszczak; J E Mathews; S Naz Masood; E Oyarzun; J Oyieke; J B Sharma; P Spark Journal: Lancet Date: 2016-05-04 Impact factor: 79.321
Authors: A J M W Vervoort; L B Uittenbogaard; W J K Hehenkamp; H A M Brölmann; B W J Mol; J A F Huirne Journal: Hum Reprod Date: 2015-09-25 Impact factor: 6.918