Related Experiment Video
Updated: Apr 26, 2026
Laparoscopic Extracorporeal Knot-Tying for Uterine Vessel Occlusion during Hysterectomy with Cervical Cerclage in Large Uteri
Published on: September 12, 2025
The risk of uterine rupture is not increased with single- compared with double-layer closure: a Swedish cohort study
S Hesselman1,2, U Högberg1, K Ekholm-Selling1
1Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
Objective:
To compare single- with double-layer closure of the uterus for the risk of uterine rupture in women attempting vaginal birth after one prior caesarean delivery.
Design:
Cohort study.
Setting:
Sweden.
Population:
From a total of 19 604 nulliparous women delivered by caesarean section in the years 2001-2007, 7683 women attempting vaginal birth in their second delivery were analysed.
Methods:
Data from population-based registers were linked to hospital-based registers that held data from maternity and delivery records. Logistic regression was used to estimate the risk of uterine rupture after single- or double-layer closure of the uterus. Results are presented as odds ratios (ORs) with 95% confidence intervals (95% CIs).
Main Outcome Measure:
Uterine rupture.
Results:
Uterine rupture during labour occurred in 103 (1.3%) women. There was no increased risk of uterine rupture when single- was compared with double-layer closure of the uterus (OR 1.17; 95% CI 0.78-1.76). Maternal factors associated with uterine rupture were: age ≥35 years and height ≤160 cm. Factors from the first delivery associated with uterine rupture in a subsequent delivery were: infection and giving birth to an infant large for gestational age. Risk factors from the second delivery were induction of labour, use of epidural analgesia, and a birthweight of ≥4500 g.
Conclusions:
There was no significant difference in the rate of uterine rupture when single-layer closure was compared with double -layer closure of the uterus.
