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Int J Gynaecol Obstet. 2011 Oct;115(1):5-10. doi: 10.1016/j.ijgo.2011.04.013. Epub 2011 Jul 26.

Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture.

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  • 1Department of Obstetrics and Gynecology, Faculty of Medicine, Universit√© Laval, Quebec, Canada.



To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture.


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.


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.


Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.

Copyright © 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

[PubMed - indexed for MEDLINE]
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