Re: One layer uterine closure
From: Bernard Cristalli (bcrist@club-internet.fr)
Sat Sep 2 01:23:06 2006
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One layer closure has been the standard of care here (France, and Europe
I believe) for the last 40 years.
I haven't seen our rupture rates at VBAC are higher than others, and we
perform a lot of VBACs.
BC
Dr. Cesar Molina a écrit :
> I am a obstetric and gynecologyc surgeon in Costa Rica and have two
> experiences with one layer uterine closure. For differente
> circumstances I have to open this patients 7 and 8 days after the
> section. It was very impressionant the irregular and bad aspect of
> uterine scarr healing in two cases. Although the inmediate evolution
> of the patients was good after reintervention(late evolution I don`t
> know), I felt very much concerned about the future evolution of their
> abdominal cavities. My impression was that this two patiens will
> depelop an important adherential syndrome. What is your experience
> about??
>
> At Sun, 10 Jun 2001, art fougner, md wrote:
>
>> germans had an entirely different experience -
>>
>> 1: Zentralbl Gynakol 1986;108(17):1039-45
>>
>> [Clinical experiences with a single layer uterine suture in cesarean
>> section].
>>
>> [Article in German]
>>
>> Winkler M, Ruckhaberle KE, Saul S, Forberg J.
>>
>> In this analysis 536 caesarean sections with a single layer uterine
>> suture were compared to 256 sections with two layer closure. Their
>> relations with regard to indications of operative delivery,
>> complications during the puerperium and their courses in subsequent
>> vaginal deliveries were taken into consideration. - The significant
>> lower rate of pyrexia and shorter hospital stay of the patients may be a
>> result of quicker and better healing of the single layer suture. The
>> increased rate of complications in the puerperium is partially due to
>> changes in the registry of dates. Absent disturbances during the
>> placental period and the occurrence of only one uterine rupture, in the
>> course of vaginal delivery in a patient with a previous single layer
>> caesarean section suture, demonstrates the functional sufficiency of
>> this technic.
>>
>> PMID: 3538711 [PubMed - indexed for MEDLINE]
>>
>> seems reasonable to perform a formal trial.
>>
>> art
>>
>> At Sun, 10 Jun 2001, Steve Raymond wrote:
>>
>>> Yes, and we are considering enrolling, but we had an experience about four years
>>> ago when one of the rural hospitals that refers to us decided to start one layer
>>> closures after reading about the Misgav-Ladach technique. We found after a few
>>> months that they were suddenly sending us problem cases of bleeding and failure
>>> of healing and such like, which had us mystified until they informed us of the
>>> change in technique, of which we had not previously been aware.
>>>
>>> Seems to me that they should have an ethical committee ruling on this!
>>> stray
>>>
>>>> The CAESAR study is recruiting in UK, is it not?
>>>>
>>>> Rupak Ranjan Roy
>>>> MRCOG
>>>>
>>> --
>>>
>>> Dr.S.H. Raymond
>>> Head of Department of O & G
>>> Empangeni Hospital
>>> South Africa 3880
>>> Phone: (+27) 35-7721111
>>> Fax: (+27) 35-7922596
>>>
>> --
>> art fougner, md
>>
>> A series of 1000 cases begins with but a single anecdote.
>>
>
