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Am J Obstet Gynecol. 2003 Oct;189(4):925-9.

Uterine rupture, perioperative and perinatal morbidity after single-layer and double-layer closure at cesarean delivery.

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Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.



This study was undertaken to evaluate the risks and benefits of single-layer uterine closure at cesarean delivery on the index and subsequent pregnancy.


A retrospective study of women delivered of their first live-born infants by primary low transverse cesarean delivery (1989-2001) and their subsequent pregnancy at our institution was performed.


Of 768 women studied, 267 had single-layer and 501 had double-layer uterine closures in the index pregnancy. Single-layer closure was associated with slightly decreased blood loss (646 vs 690 mL, P<.01), operative time (46 vs 52 minutes, P<.001), endometritis (13.5% vs 25.5%, P<.001), and postoperative stay (3.5 vs 4.1 days, P<.001). In the second pregnancy, prior single-layer closure was not associated with uterine rupture after a trial of labor (0% vs 1.2%, P=.30), or other maternal or infant morbidities. Prior single-layer closure was associated with increased uterine windows (3.5% vs 0.7%, P=.046) at subsequent cesarean delivery.


Single-layer uterine closure is associated with decreased infectious morbidity in the index surgery, but not uterine rupture or other adverse outcomes in the subsequent gestation.

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