Re: Single Layer vs Double Layer Uterine Closure
From: Braun, R. Daniel (rbraun@iupui.edu)
Wed Nov 5 11:26:57 2003
But the Bujold Gauthier study showed a higher incidence of rupture with
that single layer locking than with a double layer. Almost double I
think.
Dan
-----Original Message-----
From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of Lynn
D. Montgomery, M.D.
Sent: Wednesday, November 05, 2003 12:37 PM
To: Multiple recipients of list OB-GYN-L
Subject: Re: Single Layer vs Double Layer Uterine Closure
Dan,
I always hate to bring up anecdote without backing it up with formal
study, BUT, during my time in Houston, a locked single layer closure had
been used for years in the county, also using #1 chromic. We did not
see a significant number of ruptures (I saw one). In addition, I did
many repeats x 5-7 in which the lower uterine segment integrity was
intact. Since, I have continued to employ a locked single layer closure
and the only ruptures I have seen are in other's patients.
Again, just anecdote.
Lynn
Lynn D. Montgomery, M.D.
Rocky Mountain Women's Health
2835 Fort Missoula Rd., Suite 303
Missoula, Montana, 59804
406-549-0978
fax 406-549-0987
e-mail: apgar10@montanadsl.net
> -----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 6:48 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
>
