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  • Title: Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions.
    Author: Blumenfeld YJ, Caughey AB, El-Sayed YY, Daniels K, Lyell DJ.
    Journal: BJOG; 2010 May; 117(6):690-4. PubMed ID: 20236104.
    Abstract:
    OBJECTIVE: To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary caesarean delivery and subsequent adhesion formation. DESIGN: A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. SETTING: Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. POPULATION: One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. METHODS: Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher's exact tests and multivariable logistic regression. MAIN OUTCOME MEASURE: Prevalence rate of pelvic and abdominal adhesions. RESULTS: Of the 127 women, primary hysterotomy closure was single layer in 56 and double layer in 71. Single-layer hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72-28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions. CONCLUSIONS: Primary single-layer hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.
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