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

被引:95
|
作者
Roberge, Stephanie [1 ,2 ]
Chaillet, Nils [3 ]
Boutin, Amelie [1 ,2 ]
Moore, Lynne [2 ,4 ]
Jastrow, Nicole [5 ]
Brassard, Normand [1 ]
Gauthier, Robert J. [3 ]
Hudic, Igor [6 ]
Shipp, Thomas D. [7 ]
Weimar, Charlotte H. E. [8 ]
Fatusic, Zlatan [6 ]
Demers, Suzanne [1 ]
Bujold, Emmanuel [1 ,2 ]
机构
[1] Univ Laval, Dept Obstet & Gynecol, Fac Med, Quebec City, PQ G1V 4G2, Canada
[2] Univ Laval, Dept Social & Prevent Med, Fac Med, Quebec City, PQ G1V 4G2, Canada
[3] Univ Montreal, Fac Med, Dept Obstet & Gynecol, Montreal, PQ H3C 3J7, Canada
[4] Ctr Hosp Affilie Univ Quebec, Hop Enfant Jesus, Quebec City, PQ, Canada
[5] Univ Geneva, Dept Obstet & Gynecol, Fac Med, Hop Univ Geneve, Geneva, Switzerland
[6] Univ Clin Ctr, Clin Gynecol & Obstet, Tuzla, Bosnia & Herceg
[7] Harvard Univ, Brigham & Womens Hosp, Dept Obstet & Gynecol, Sch Med, Boston, MA 02115 USA
[8] Univ Med Ctr Utrecht, Dept Obstet & Gynecol, Utrecht, Netherlands
基金
加拿大健康研究院;
关键词
Cesarean delivery; Hysterotomy; Pregnancy; Uterine rupture; Vaginal birth after cesarean; VAGINAL BIRTH; MISGAV-LADACH; 2-LAYER CLOSURE; SECTION; METAANALYSIS; MORBIDITY; IMPACT; TRIAL;
D O I
10.1016/j.ijgo.2011.04.013
中图分类号
R71 [妇产科学];
学科分类号
100211 ;
摘要
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 [Cl] 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% Cl 2.58-9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% Cl 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 (C) 2011 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
引用
收藏
页码:5 / 10
页数:6
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