Transverse uterine incision closure: one versus two layers.

Area of Science:

• Obstetrics and Gynecology
• Surgical Techniques

Background:

• Cesarean delivery is a common surgical procedure.
• Uterine incision closure is a critical step in cesarean delivery.
• Standard practice often involves two-layer closure of the uterine incision.

Purpose of the Study:

• To compare the outcomes of one-layer versus two-layer closure of low transverse cesarean incisions.
• To evaluate operative time, hemostasis, and infectious morbidity.

Main Methods:

• Randomized controlled trial involving 906 women undergoing low transverse cesarean section.
• Participants were randomized to either one-layer or two-layer uterine incision closure.
• Statistical analysis included Student t test, chi-squared test, and Wilcoxon rank sum test.

Main Results:

• One-layer closure significantly reduced operative time (43.8 vs. 47.5 minutes, p = 0.0003).
• Fewer additional hemostatic sutures were needed with one-layer closure (p = 0.046).
• Incidence of endometritis was comparable between one-layer (22%) and two-layer (18%) closure groups (p = 0.17).

Conclusions:

• One-layer closure of low transverse cesarean incisions is associated with reduced operative time and improved hemostasis.
• Infectious morbidity rates are similar for both closure techniques.
• One-layer closure is recommended when anatomically feasible.