Single-Layer Uterine Incision Closure and Subsequent Trial of Labor

Abstract

The purpose of this study was to compare the pregnancy outcomes subsequent to single-versus two-layer closure of a prior uterine incision. The null hypothesis is that there is no difference in the rate of uterine scar separation after single- versus two-layer closure. Records of 443 consecutive patients who had a previous cesarean section and a subsequent delivery in the University of Louisville hospital were reviewed retrospectively for the delivering physicians' assessment of the previous uterine scar, either after a vaginal delivery or cesarean section. Data were also collected regarding maternal and fetal morbidity in both the preceding and index pregnancies. Eighty-two patients had a single-layer closure and 361, a two-layer closure of a previous uterine incision. Sixty of 82 and 281 of 361 patients underwent a trial of labor. Sixty percent (49/82) of the single-layer group delivered vaginally versus only 40% (145/361) of the two-layer group. The incidence of uterine window (3) or rupture (1) in the ...