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

International Journal of Gynecology & Obstetrics, 08/10/2011

Roberge S et al. – Locked but not unlocked single–layer closures were associated with a higher uterine rupture risk than double–layer closure in women attempting a TOL.


  • 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.

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