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Re: Single Layer vs Double Layer Uterine ClosureFrom: Braun, R. Daniel (rbraun@iupui.edu)Wed Nov 5 10:17:58 2003
An extra interrupted if needed. Seldom is as I close the whole thing through and through. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Douglas Krell Sent: Wednesday, November 05, 2003 11:20 AM To: Multiple recipients of list OB-GYN-L Subject: Re: Single Layer vs Double Layer Uterine Closure Dan With a single NON-locking closure, what steps do you take to control areas of bleeding? Douglas Krell MD
> ----- Original Message ----- Locking creates necrosis within the locked area of tissue. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Richard Chudacoff, MD Sent: Wednesday, November 05, 2003 9:25 AM To: Multiple recipients of list OB-GYN-L Subject: RE: Single Layer vs Double Layer Uterine Closure Why would not locking make that much of a difference? I've always locked (and I must say, Dan, my numbers are probably far less then yours just based on expose to the practice) and have seen my incisions on repeat sections that look quite sturdy. Nor am I aware of any of successive pregnancies after my c-section that has ruptured. Of course, my case list is slightly* less than 10,000. *-probably less than 1000 as well-not including my Ben Taub experience. Richard Chudacoff, MD The more laws, the less justice. Marcus Tullius Cicero -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net]On Behalf Of Braun, R. Daniel Sent: Wednesday, November 05, 2003 7:48 AM To: Multiple recipients of list OB-GYN-L Subject: RE: Single Layer vs Double Layer Uterine Closure If you all remember, I made a big point out of the fact that in the McGill study, all of the single layer closures were running lock stitches. This article does not state whether or not the single layers were locked. It just says a continuous running suture. I would think that they were not locked since it doesn't specify, but you know what assuming does. I have closed mine with a running NON locked single layer of Number 1 chromic catgut for a long time. I really think that not locking makes a big difference. Dan -----Original Message----- From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of art fougner, md Sent: Tuesday, November 04, 2003 12:46 PM To: Multiple recipients of list OB-GYN-L Subject: OB: Single Layer vs Double Layer Uterine Closure This was kicked around awhile ago - here's more fuel to the fire - this from the October Gray Journal. Uterine rupture, perioperative and perinatal morbidity after single-layer and double-layer closure at cesarean delivery Celeste Durnwald, MD [MEDLINE LOOKUP] Brian Mercer, MD [MEDLINE LOOKUP] Abstract Objective This study was undertaken to evaluate the risks and benefits of single-layer uterine closure at cesarean delivery on the index and subsequent pregnancy. Study design 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. Results 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. Conclusion 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 -- art fougner, md ich bin ein New Yorker
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