Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions

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.