Single- versus double-layer hysterotomy closure at primary caesarean delivery and bladder adhesions

Objective To determine the association between single-layer (one running suture) and double-layer (second layer or imbricating suture) hysterotomy closure at primary caesarean delivery and subsequent adhesion formation. Design A secondary analysis from a prospective cohort study of women undergoing first repeat caesarean section. Setting Department of Obstetrics and Gynecology, Stanford University, Stanford, CA, USA. Population One hundred and twenty-seven pregnant women undergoing first repeat caesarean section. Methods Patient records were reviewed to identify whether primary caesarean hysterotomies were closed with a single or double layer. Data were analysed by Fisher's exact tests and multivariable logistic regression. Main outcome measure Prevalence rate of pelvic and abdominal adhesions. Results Of the 127 women, primary hysterotomy closure was single layer in 56 and double layer in 71. Single-layer hysterotomy closure was associated with bladder adhesions at the time of repeat caesarean (24% versus 7%, P = 0.01). Single-layer closure was associated in this study with a seven-fold increase in the odds of developing bladder adhesions (odds ratio, 6.96; 95% confidence interval, 1.72-28.1), regardless of other surgical techniques, previous labour, infection and age over 35 years. There was no association between single-layer closure and other pelvic or abdominal adhesions. Conclusions Primary single-layer hysterotomy closure may be associated with more frequent bladder adhesions during repeat caesarean deliveries. The severity and clinical implications of these adhesions should be assessed in large prospective trials.