Re: One layer uterine closure
From: Efrain Ramirez (eramirezt@coqui.net)
Fri Sep 8 21:27:42 2006
Same here Ron - I am reaching 30 years :) un abrazo,
Ef
>>At Fri, 8 Sep 2006, ainsron wrote:
>
>I've locked the first layer for 25+ years and unlocked the second layer with
>an imbricating stitch - so I guess I'm a hybrid. I also close the bladder
>flap most of the time. Looking back when I do repeats, I have not seen a
>significant number of adhesions or complications, compared to repeats I do
>on other patients who move into my practice. Like you Efrain, I'll continue
>doing it my way unless I see evidence that it is not working or I am placing
>my patients at risk.
>
>Ronald E. Ainsworth, MD, FACOG
>
>-----Original Message-----
>From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Efrain
>Ramirez
>Sent: Friday, September 08, 2006 4:38 AM
>To: Multiple recipients of list OB-GYN-L
>Subject: Re: One layer uterine closure
>
>I use unlocked 2 layers.. until the evidence shows something
>better....thanks..
>
>Ef
>
>>At Thu, 7 Sep 2006, R. Daniel Braun wrote:
>>
>>If you read the whole article, you will find that the single layer closures
>>were all LOCKED sutures. This would make a big diference. The study needs
>>to be done comparing with UNLOCKED single layer.
>>
>>Dan
>>
>>On 9/7/06, Efrain Ramirez <eramirezt@coqui.net> wrote:
>>>
>>> At Thu, 7 Sep 2006, R. Daniel Braun wrote:
>>> >
>>> >OOOOOOOOHHHH!!!!!!!!!!!
>>> >Data???
>>> >
>>> >Dan
>>> The impact of a single-layer or double-layer closure on uterine rupture.
>>> Bujold E, Bujold C, Hamilton EF, Harel F, Gauthier RJ
>>>
>>> Am J Obstet Gynecol (2002 Jun) 186(6):1326-30 ISSN: 0002-9378
>>>
>>> Obstetric Surgical Procedures
>>> Uterine Rupture
>>> Cohort Studies
>>> Comparative Study
>>> Female
>>> Human
>>> Odds Ratio
>>> Pregnancy
>>> Recurrence
>>> Trial of Labor
>>>
>>> Abstract
>>>
>>> OBJECTIVE: Our purpose was to measure the impact of a single-layer or
>>> double-layer closure on uterine rupture at subsequent delivery.
>>>
>>> STUDY DESIGN: This is an observational cohort study of all women
>>> undergoing a trial of labor from 1988 to 2000 in a tertiary care center,
>>> after a single low transverse cesarean delivery. Factors most highly
>>> associated with uterine rupture were identified by using univariate
>>> regression analysis. Multivariate logistic regression analysis was used
>>> to adjust for selected confounding variables.
>>> Top of Abstract
>>> RESULTS: Of the 2142 women who met the study criteria, 1980 (92.4%) had
>>> maternal records and original operative reports reviewed. After
>>> adjustments were made for confounding variables, the odds ratio for
>>> uterine rupture in women with a single-layer closure was 3.95 (95% CI,
>>> 1.35- 11.49).
>>>
>>> CONCLUSION: A single-layer closure of the previous lower segment
>>> incision was the most influential factor and was associated with a
>>> 4-fold increase in the risk of uterine rupture compared with a
>>> double-layer closure.
>>>
>>> --
>>> R. Daniel Braun
>>>
>>> "The way to health is an aromatic bath and scented massage
>>> everyday".
>>> Hippocrates
>
>--
>" The greatest obstacle to knowledge is not ignorance,
>it is the illusion of knowledge." Daniel J. Boorstin - Historian
>
--
“ The greatest obstacle to knowledge is not ignorance,
it is the illusion of knowledge.” Daniel J. Boorstin - Historian
