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One- Versus Two-Layer Closure of a Low Transverse Cesarean: The Next Pregnancy

Obstetrics & Gynecology: January 1997
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Objective To determine whether a low transverse cesarean closure method in one or two layers affects subsequent pregnancy outcome.

Methods In a prospective trial reported previously, 906 women were assigned randomly to either one- or two-layer uterine closure. One hundred sixty-four women had a subsequent pregnancy and delivery (18 weeks' gestation or longer) at our institution. Maternal and neonatal outcomes were ascertained by medical chart review and compared between the one- and two-layer closure groups.

Results Of the 164 subsequent deliveries, 83 had previous closure in one layer, whereas 81 had involved a two-layer closure. The demographic characteristics of these two groups were similar. Nineteen women (12%) underwent elective repeat cesareans without labor, and the remaining 145 experienced labor. Length of labor, mode of delivery, duration of hospital stay, gestation at delivery, and the incidences of uterine scar dehiscence, chorioamnionitis, postpartum metritis, hemorrhage, transfusion, and abnormal placentation did not differ significantly between the groups. Selected neonatal outcomes, including Apgar scores, cord pH, birth weight, and perinatal death, were similar between groups as well.

Conclusions These findings suggest that the type of low transverse cesarean closure does not significantly affect the outcome of the next pregnancy.

Address reprint requests to: Shelley J. Chapman, MD, Department of Obstetrics and Gynecology, The Women's Hospital of Greensboro, 801 Green Valley Road, Greensboro, NC 27408.

© 1997 The American College of Obstetricians and Gynecologists

Closure of a low transverse incision in one continuous locking layer or with a two-layer imbricating method makes no difference in subsequent pregnancy outcomes.