Single- Versus Double-Layer Closure of the Hysterotomy Incision During Cesarean Delivery and Risk of Uterine Rupture
Bibliographic record
Abstract
Techniques used for closure of the hysterotomy site following cesarean delivery include the use of interrupted, locked, and unlocked continuous sutures with single- or double-layer closure. The specific technique used may be associated with risk of uterine rupture during a trial of labor (TOL) in future pregnancies. In a recent systematic review, single-layer closure but not double-layer closure was shown to reduce operating time and blood loss. However, a large randomized controlled trial published in 2010 found no such benefit for single-layer closure. This systematic review and meta-analysis compared the effect of single- versus double-layer closure on risk of uterine rupture. A search of the electronic databases—PubMed, Embase, and Cochrane Central Register of Controlled Trials—was conducted to identify relevant citations published up to 2010 that included data on women with a previous single, low, transverse cesarean delivery who underwent TOL. Both observational and experimental studies were included in the search. To assess the risk of uterine rupture and uterine dehiscence, random effects models were used to calculate pooled odds ratios (ORs). Data from 9 studies including 5810 women met inclusion criteria for the meta-analysis. There was no statistically significantly higher overall risk of uterine rupture during TOL after use of a single-layer closure compared with a double-layer closure; the OR was 1.71, with a 95% confidence interval [CI] of 0.66–4.44 (P = 0.27). Compared with a double-layer closure, the use of a locked single-layer closure (OR, 4.96; 95% CI, 2.58–9.52, P < 0.001) but not an unlocked single-layer closure (OR, 0.49; 95% CI, 0.21–1.16, P = 0.1) was associated with increased risk of uterine rupture. These findings show that the risk of uterine rupture in women attempting a TOL is significantly higher with use of a locked single-layer closure than either an unlocked single-layer closure or a double-layer closure.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.006 | 0.022 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.009 | 0.020 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".