Continuous, nonlocking, single-layer repair of the low transverse uterine incision

Continuous, locking, single-layer closure of the low transverse uterine incision has been used, with a reportedly decreased risk of endometritis, decreased operating time and no increased risk of rupture with subsequent vaginal birth when compared with the more traditional, two-layer repair. However, in other tissues, such as fascia and skin, locking sutures cause increased tissue damage and weaker scars. We decided to determine the safety in the perioperative period of continuous, nonlocking, single-layer repair. Over a six-month period, 100 patients who had continuous, nonlocking, single-layer repair of their low transverse uterine incisions were compared with 100 matched controls who had the traditional, two-layer repair of a locking suture followed by an imbricating layer. Febrile morbidity, rates of endometritis, blood loss, requirements for additional hemostatic sutures and operating times were compared. Except for increased additional hemostatic suture use and decreased operating times in the single-layer group, we found no differences between the two methods. The continuous, nonlocking, single-layer technique is not only expedient and cost efficient but also safe in the perioperative period. It has the additional theoretical advantage of less tissue damage, which may result in a stronger wound and thus in a reduced risk of rupture with subsequent labor.