Single-Layer Uterine Incision Closure and Subsequent Trial of Labor

Abstract

The purpose of this study was to compare the pregnancy outcomes subsequent to single-versus two-layer closure of a prior uterine incision. The null hypothesis is that there is no difference in the rate of uterine scar separation after single- versus two-layer closure. Records of 443 consecutive patients who had a previous cesarean section and a subsequent delivery in the University of Louisville hospital were reviewed retrospectively for the delivering physicians' assessment of the previous uterine scar, either after a vaginal delivery or cesarean section. Data were also collected regarding maternal and fetal morbidity in both the preceding and index pregnancies. Eighty-two patients had a single-layer closure and 361, a two-layer closure of a previous uterine incision. Sixty of 82 and 281 of 361 patients underwent a trial of labor. Sixty percent (49/82) of the single-layer group delivered vaginally versus only 40% (145/361) of the two-layer group. The incidence of uterine window (3) or rupture (1) in the single-layer group did not differ from that in 361 control patients (2 and 0, respectively). An excess of maternal infectious morbidity was not observed in either group and neonatal outcomes were similar. Conclusion: Pregnancy outcomes subsequent to single-layer closure are indistinguishable from those in patients having a standard two-layer closure.

Key Words:

• Trial of labor
• Operative obstetrics
• Surgical technique