Notice bibliographique
Résumé
In a large cohort study including more than 7600 women with previous caesarean section, Hesselman et al. observed a similar rate of uterine rupture in women with a single-layer closure compared with women with a double-layer closure of the uterus at previous caesarean section (adjusted relative risk 1.13; 95% confidence interval [95%] 0.75–1.70). (Hesselman et al. BJOG 2014; doi: 10.1111/1471-0528.13015) This finding is in agreement with a recent meta-analysis showing no significant difference between the two types of closure (odds ratio [OR] 1.17; 95% CI 0.66–4.44). (Roberge et al. Int J Gynaecol Obstet 2011;115:5–10). There is therefore accumulating observations suggesting a minor role, if any, for the number of layers used for uterus closure on the risk of uterine rupture in the next pregnancy. However, other aspects of uterus closure have to be closely evaluated. The latter meta-analysis suggests that a locked single-layer closure could be related to uterine rupture (OR 4.96; 95% CI 2.58–9.52), which is in agreement with another meta-analysis of randomised trials showing that locking a single-layer can lead to a thinner residual myometrium thickness evaluated by ultrasound after caesarean (Roberge et al. Am J Obstet Gynecol 2014 in press). There are at least two potential explanations beyond such association: it is possible that the locked suture, by being more haemostatic, can cause a strangulation of the scar tissue and lead to weaker healing. It is also possible that the weakness of the scar is secondary to the fact that this technique is usually performed with inclusion of the inner part of the uterine wall (decidua/endome-trium) in the scar tissue (Figure 1). In several animal models, Poidevin demonstrated that suturing the complete thickness of the uterus, including the endometrium, was associated with inclusions of endometrial tissue in the scar, resulting in scar defects several weeks or months later (Poidevin. Cesarean section scars. Springfield [IL]: Charles C. Thomas Publisher; 1965). Beside the incomplete healing and the increased risk of uterine rupture, another multicentre case–control study reported that including the inner side of the uterine wall (decidua/endometrium) into the scar with a continuous suture, was associated with an increasing rate of placenta accreta in women with placenta praevia, independently of the number of layers used for uterus closure (Sumigama et al. BJOG 2014;121:866–74). Therefore, the cumulative evidence suggests that continuous suture with inclusion of the inner side of the uterine wall (decidua/endometrial layer) at the time of caesarean section is associated with impaired uterine scar evaluated by ultrasound, and with potential long-term consequences such as placenta accreta. Original works from our group (Bujold et al. Am J Obstet Gynecol 2002;186:1326–30; Bujold et al. Obstet Gynecol 2010;116:43–50) suggest a significant increase of uterine rupture with single-layer closure, perhaps related to the fact that the single-layer closure typically used in North America included the full uterine wall and its inner side into the scar. Future comparative studies, including observational and randomised trials, should focus not necessarily on the number of layers at the time of caesarean but on the inclusion or exclusion of the endometrium in the first layer. There are no conflicts of interest to disclose.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,014 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».