International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics · 2011
Single- versus double-layer closure of the hysterotomy incision during cesarean delivery and risk of uterine rupture.
СтатьяМетаанализПоддержка исследования: вне правительства СШАОбзорНазвание и аннотация: Перевод в очереди
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Roberge Stéphanie, Chaillet Nils, Boutin Amélie, Moore Lynne, Jastrow Nicole, Brassard Normand, Gauthier Robert J, Hudic Igor, Shipp Thomas D, Weimar Charlotte H E, Fatusic Zlatan, Demers Suzanne, Bujold Emmanuel
Аннотация
OBJECTIVE: To evaluate the best available evidence regarding the association between single-layer closure and uterine rupture.
METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model.
RESULTS: Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure.
CONCLUSION: Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.
METHODS: The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for relevant observational and experimental studies that included women with a previous single, low, transverse cesarean delivery who had attempted a trial of labor (TOL). The risks of uterine rupture and uterine dehiscence were assessed by pooled odds ratios (OR) calculated with a random effects model.
RESULTS: Nine studies including 5810 women were reviewed. Overall, the risk of uterine rupture during TOL after a single-layer closure was not significantly different from that after a double-layer closure (OR 1.71; 95% confidence interval [CI] 0.66-4.44). However, a sensitivity analysis indicated that the risk of uterine rupture was increased after a locked single-layer closure (OR 4.96; 95% CI 2.58-9.52, P<0.001) but not after an unlocked single-layer closure (OR 0.49; 95% CI 0.21-1.16), compared with a double-layer closure.
CONCLUSION: Locked but not unlocked single-layer closures were associated with a higher uterine rupture risk than double-layer closure in women attempting a TOL.