Risk of uterine rupture

If you are to have an elective C section, please ensure that you are double stitched up, not single stitched . . please read on ..

AIMS Journal, Spring 2004, Vol 16 No 1

Risk of uterine rupture

A single-layer, rather than a double-layer, closure of the incision after a caesarean may greatly increase the risk of uterine rupture in a later pregnancy. Single-layer closure is becoming popular with doctors because it can be done more quickly, and mothers have fewer problems afterwards.

Obstetricians in Montreal up to 1988 used the doublelayer closure – a continuous interlocking thread through the myometrium followed by a continuous second layer, and finally closure of the peritoneum. In the ‘new’ method, the entire thickness of the uterine wall is closed with a single continuous suture.

Researchers looked at records of over 2000 women who had had only one caesarean section and a trial of labour for their next baby during 1988-2000. The uterus ruptured in 3.1 per cent of the women who had single-layer closure vs 0.5 per cent of those with a double-layer closure. It was found that single-layer closure was the biggest risk for rupture, increasing the risk by nearly four times. The second greatest risk factor was having another baby within two years of the section, which could increase risk by nearly two-and-a-half times.

If the scar doesn’t rupture, but only comes apart (dehiscence), this may not be detected unless the woman has a section. Among those who had another caesarean, twice as many in the single-layer group (7.3 per cent) had a dehiscence as in the double-layer group (3.1 per cent).

It was suggested that, for women who may give birth vaginally next time, surgeons should use the double-layer technique.

(AIMS comments)

A randomised trial of the two methods of closure is ongoing in the UK. It is interesting to see that, in the above trial, they did not use prostaglandins, and use of oxytocin did not significantly increase the risk of rupture. We have certainly seen cases where the use of prostaglandins was associated with scar rupture.

  • Bujold E et al. The impact of a single-layer or double-layer closure on uterine rupture. Am J Obstet Gynecol, 2002; 186: 1326-9

Why have I put this here?