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Re: One layer uterine closure From: Atkinson, Samuel M (ATKINSONS@ECU.EDU) Fri Sep 8 11:30:26 2006 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Larry Glazerman: "GARDASIL - was Squamous metaplasia vs. ASC-H" Previous message: Atkinson, Samuel M: "Re: Squamous metaplasia vs. ASC-H" Maybe in reply to: Dr. Cesar Molina: "One layer uterine closure" I'm afraid there won't be a true controlled study. Does one lock tightly or loosely? Likewise one can pull an unlooped suture very tight, only to have your assistant let it go loose-or pull it even tighter. Is the goal to approximate, strangulate or hemostasis. Seems to me very different strokes with different folks becomes an amalgum with no study meaningful. sAm ________________________________ From: ob-gyn-l@obgyn.net on behalf of ainsron ________________________________ Sent: Fri 9/8/2006 11:14 AM To: Multiple recipients of list OB-GYN-L Subject: Re: One layer uterine closure 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 Next message: Larry Glazerman: "GARDASIL - was Squamous metaplasia vs. ASC-H" Previous message: Atkinson, Samuel M: "Re: Squamous metaplasia vs. ASC-H" Maybe in reply to: Dr. Cesar Molina: "One layer uterine closure"

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